Kidney disease and diabetes
More than half a million people worldwide have a kidney transplant and many more are waiting for one. People with kidney disease have a much higher risk of developing a number of diseases, particularly cardiovascular disease. In Diabetes Mellitus blood sugar levels are raised over a prolonged period. People with diabetes are at increased risk of cardiovascular disease, kidney disease and damage to the eyes. Rates of type-2 diabetes have increased rapidly in recent decades due to changes in diet and other lifestyle factors.
Our main contribution to understanding the causes and treatment of chronic kidney disease to date is the Study of Heart and Renal Protection (SHARP). With about 9,400 patients in 400 hospitals in 18 countries, this is the largest randomised trial yet involving patients with chronic kidney disease. The results showed that lowering these patients' blood cholesterol reduced their risk of heart attacks and strokes, and has resulted in the widespread use of statin-based treatment in people with chronic kidney disease worldwide.
People who receive a kidney transplant need drugs to prevent their body from rejecting the new kidney but standard medications to prevent rejection may also cause long-term damage to the kidney. We coordinated the Campath, Calcineurin inhibitor reduction and Chronic allograft nephropathy (3C) trial which recruited 850 patients at the time of their kidney transplant. The 3C trial tested two new treatments which might avoid this long-term damage.
The UK-HARP-III trial, assessed the effects of the drug sacubitril/valsartan on the progression of kidney disease as compared to standard treatment (irbesartan).
With over 15,000 participants, our ASCEND trial was one of the largest randomised trials to investigate whether aspirin and omega-3 fatty acids are effective in preventing cardiovascular disease in people with diabetes.
ASCEND PLUS is a UK-wide clinical trial testing whether the tablet medication oral semaglutide, might help to protect against heart attacks, strokes and circulatory problems in people with type 2 diabetes.
Our EMPA-KIDNEY trial which studied 6609 volunteer kidney patients, showed that empagliflozin reduces the risk of needing dialysis or a kidney transplant or death from cardiovascular disease in people who have kidney disease. Empagliflozin is now recommended for most adults with chronic kidney disease worldwide.
EASi-KIDNEYTM is a new international, multi-centre trial building on our previous work. The trial aims to recruit about 11,000 people with chronic kidney disease, with or without type 2 diabetes to assess whether a new drug, currently called BI 690517, reduces the risk of kidney disease progression, hospitalisation for heart failure or death from cardiovascular disease in people with chronic kidney disease when it is added to standard care including empagliflozin.
Large cohorts, including the China Kadoorie Biobank (CKB), UK Biobank and the Mexico study in which participants have provided blood samples, will provide new insights into the causes of diabetes, which will lead to better ways to prevent and treat the condition.