Patient commitment powers renal research
Within the busy clinical environment of the Royal North Shore Hospital (RNSH) Renal Clinic, clinical trials manager Rebecca Stevenson looks after a significant research portfolio, with around 20 clinical trials in progress at any time.
“Not only will they actively take a dummy tablet for up to five years but they will come in regularly for their visits, and have extra cardiac scans and blood tests,” she says. “In a very generous way, they help us understand whether this medication could be an effective way to improve quality of life and reduce hospitalisations for millions of patients like them in the future.” Rebecca says she consistently sees this level of patient commitment across other RNSH renal trials. Many of the patients have had kidney disease from a young age; others live with autoimmune kidney disease where their own body attacks the kidneys. “They are generally well informed about their kidney health,” she says. “These patients understand the potential decline in kidney function over time and they’re only too willing to be part of the research.” For example, in another trial, patients with another form of kidney disease called IgA nephropathy are injecting themselves fortnightly under the skin with a medication that may also be a placebo. “They are willing to follow a strict regimen and dose themselves at home in order to help further medical research.” To maximise the reach of these trials, RNSH also collaborates with the George Institute for Global Health on the Renal LifeCycle and other studies.
The studies are diverse and span early recruitment to long-term follow-up. Some are international, sponsored by major pharmaceutical companies, while others are led by RNSH clinicians investigating innovative treatments to improve clinical practice and answer important questions arising directly from patient care. Rebecca says much of the work focuses on finding better ways to slow the decline in kidney function for patients living with chronic kidney disease. “Research is often a long game. While we occasionally see results quickly, more often the outcomes won’t be published for two-to-five years,” she says. But what consistently impresses Rebecca is the extraordinary generosity and altruism of the patients who join the clinical trials. She cites the example of the Renal LifeCycle trial, a large global research project investigating dapagliflozin, a medication known as an SGLT2 inhibitor, which is currently used to treat type 2 diabetes, heart failure and certain stages of chronic kidney disease. SGLT2 inhibitors help the body remove excess sugar through the urine. Although dapagliflozin is already approved for some kidney disease patients, it is not yet available for people on dialysis or those who have received a kidney transplant. The trial, involving more than 1,500 patients worldwide, is examining whether it is safe and effective for these groups of patients. Rebecca says there are currently 22 RNSH patients in the study, some of whom are willing to take a placebo for up to five years.
18 Tomorrow’s medicine today
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