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More than 240,000 people with kidney failure are treated with peritoneal dialysis (PD) worldwide. Cardiff University pioneered novel test methods that identified deleterious dialysis solution components, leading directly to manufacturers introducing more biocompatible dialysis fluids that improve patient outcomes. Cardiff investigators designed and ran the early clinical studies on these new fluids, which now lead the PD solutions market worldwide, and are recommended in European clinical guidelines. Recent evidence suggests that their use reduces peritonitis severity, decreases peritonitis incidence by 40% and mortality by 30%, resulting in reduced hospitilsation and significant healthcare savings.
Research led by Professor Paul J Thornalley since 1993, (University of Warwick, 2007-present), revealed the formation of harmful reactive dicarbonyl compounds (also known as glucose degradation products, GDPs) within the glucose osmolyte of first-generation peritoneal dialysis (PD) fluids. Clinical studies confirmed the increased damage to proteins in patients on PD therapy. In response to these findings, major manufacturers of PD fluids changed their manufacturing processes to minimise GDP content by separating glucose and buffer components within two-compartment bags for heat sterilisation, and by using osmolyte that is resistant to thermal degradation. PD fluids with low GDP content have been associated with improved clinical outcomes for patients receiving dialysis, including maintained residual renal function, decreased peritonitis, and decreased fluid infusion pain. They have been widely implemented in clinical use since 2010. Globally, approximately 240,000 patients receive PD therapy.
Dialysis has revolutionised the management of End Stage Kidney Disease (ESKD), but the benefits of this invasive, demanding treatment may not be clear-cut for elderly, frail patients with other serious comorbidities. University of Hertfordshire and East and North Hertfordshire NHS Trust researchers have led the development of Conservative Management, an alternative to dialysis for some patients, providing multidisciplinary support and careful symptomatic management until death. The research shows that quality of life is maintained, survival may not be significantly compromised, and preferred place of death is more often achieved than for counterparts on dialysis. Conservative Management programmes have been adopted across the UK and elsewhere, influencing the care of many patients.
Bruch's membrane is a structure in the retina responsible for "waste disposal." Scientists at KCL have provided evidence that matrix metalloproteinase enzymes clear debris from the membrane and that a loss of this activity contributes to a build-up of debris that causes a decline in visual function with normal aging or a more rapid decline in individuals with retinal disease. This has resulted in the development of a highly innovative Retinal Rejuvenation Therapy based on the use of pain-free nanosecond laser pulses to the eye that stimulate a "cleansing" response to improve nutrient supply across, and waste removal from, Bruch's membrane. Clinical studies suggest that this novel treatment has the potential to significantly improve the quality of life of people suffering from age-related macular degeneration and diabetic retinopathy, diseases that cause vision impairment and blindness in millions of people worldwide.
Research at the Department of Engineering Science has led to step changes in the way industrial membrane filtration plants are designed and operated . Based on some key research results that have successfully tackled membrane fouling problems, the work has triggered rapid uptake of membrane-based technologies that are more energy-efficient than traditional processes. Water companies are among those achieving both economic and the environmental benefits, and the research has played a key role in the membrane bioreactor (MBR) market, which is now growing at over 10% a year, and in the global desalination market which exceeds US$19 billion, according to GMR Data (2012) [13].
Original research carried out by The University of Nottingham has shown that both knowledge and practice related to perioperative fluid prescribing was poor, resulting in significant and avoidable postoperative morbidity. We have shown that maintaining patients in as near a state of zero fluid balance as possible reduces hospital stay by 3.4 days and complication rate by 41%. Our work guided the formulation of the British Consensus Guidelines and NICE Guidelines on intravenous fluid therapy for adult surgical patients. It has also reduced the frequency of postoperative fluid overload, and led to improved patient outcome and potential financial benefits of £122m per year for NHS England.
Through the mathematical modelling of biomedical processes, outcomes for patients with multiple myeloma (a form of bone cancer that can lead to kidney failure, a major cause of morbidity) have been vastly improved, with the result that dialysis treatment may no longer be necessary alongside their myeloma treatment. Regaining kidney function for these patients improves their quality of life and results in significant cost savings for the NHS. Research into the modelling of the kinetics of whole antibodies produced by multiple myeloma patients (and others) has also had an impact on patient outcomes and clinical decisions. There have also been economic benefits for Gambro, a German company that sells products developed on the basis of the research results.
Research conducted by Professor Tim Goodship and co-workers at Newcastle has had a profound effect on the prognosis for patients with atypical haemolytic uraemic syndrome (aHUS). By engaging in research on the genetic factors underlying the disease they developed an understanding of the molecular mechanisms responsible. Identifying that the majority of patients with aHUS have either acquired or inherited abnormalities of the regulation of complement (part of the immune system) led to the establishment of a UK national service for genetic screening and treatment with the complement inhibitor eculizumab. As eculizumab is now available to patients in England, the progression to end-stage renal failure can be prevented and patients already on dialysis will soon be successfully transplanted.
Research at UCL firmly established tacrolimus as the optimal calcineurin inhibitor to use in immunosuppressive regimens following liver transplantation. Compared to ciclosporin its use improved graft survival by 6% and patient survival by 7%. Assuming 550 liver transplants per year in the UK since 2008, we can estimate that, with 90% of patients treated with tacrolimus and 10% ciclosporin, tacrolimus-based immunosuppression has resulted in 165 grafts and 192 lives being saved during the period 2008-13.