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Landmark study provides key to improved survival in peritoneal dialysis patients

20 September 2013

-Inflammation identified as reason why only 1 in 10 patients survive beyond 10 years on dialysis

-Current therapy is hampered by infection and membrane failure

-New insights clear way for more targeted therapies and improved treatments

Clinicians and scientists from Cardiff and Keele Universities have published data from a landmark study that explains why survival in patients on peritoneal dialysis is low.

Peritoneal dialysis (PD) is a treatment for over 250,000 patients with chronic kidney disease worldwide, using the patient’s peritoneum in the abdomen. Currently, only one in ten PD patients survives beyond 10 years on dialysis. For each one-year increase in the patient’s age, the risk of death increases by 4% and patients with diabetes have a 30% increased risk of death.

Scientists have now discovered that inflammation in the body and in the peritoneal cavity (where dialysis is performed) are a separate process, which has implications for both the ability to perform dialysis and patient survival. In effect, systemic (whole body) inflammation controls the outcome (survival) whilst peritoneal inflammation controls membrane survival.

Professor Nicholas Topley from Cardiff University and Professor Simon Davies from Keele University designed the study that has taken 12 years to complete:

"Improving survival and doing better dialysis to improve quality of life is the key goal of our research," said Professor Topley from Cardiff University’s School of Medicine. "This study was a hard one to bring home because of its length of follow up and the logistics of collecting patient samples worldwide. The importance of the results is self-evident - this is a big leap forward for PD."

Professor Simon Davies, lead investigator from Keele University, said: "We will now be able to target inflammation to improve survival and recovery. Of course there is more to be done but this will form the basis of understanding that to holistically treat the patient one needs to define the clinical problem."

The 12-year international study, with 10 centres in the UK, Korea and Canada, is the longest and largest of its kind. Researchers recruited more than 1500 patients to the study over a 10-year period and then performed a detailed clinical and immunological analysis of samples obtained from PD patients. This for the first time characterised inflammation in these patients and linked it directly to patient outcomes.

The data will enable clinicians who treat PD patients to be able to target treatment where it is needed, thereby improving and extending the therapy, quality of life and reducing treatment failure.

Dialysis treatment is a daily reality for patients with kidney failure which can last for many years and incurs a huge annual cost for the NHS. A UK estimate suggests that renal disease costs the NHS in England £1.45 billion and £800million in Wales, annually.

More than 250,000 patients worldwide use peritoneal dialysis as their primary form of renal replacement therapy.

The paper, entitled ‘Independent Effects of Systemic and Peritoneal Inflammation on Peritoneal Dialysis Survivalis published today in the Journal of the American Society of Nephrology. An online version can be accessed here.

The research was funded by Baxter Healthcare’s Renal Division and the International Society for Peritoneal Dialysis and is endorsed by the ISPD and the British Renal Society.


Useful links:

Cardiff University School of Medicine
Peritoneal Immunity Group
Professor Nicholas Topley
Peritoneal Immunity
Professor Simon Davies

For further information or to arrange an interview, please contact:

Professor Nicholas Topley
Mobile : +44 (0)7778290373
Tel: 02920-743770
Home: 01446 720598
PA Neried Evelyn-Gauci: 02920-743770

Tomas Llewelyn Barrett
Public Relations
Cardiff University
Tel: 029 20 875 596
Mobile: 07950792532

Cardiff University
Cardiff University is recognised in independent government assessments as one of Britain’s leading teaching and research universities and is a member of the Russell Group of the UK’s most research intensive universities. Among its academic staff are two Nobel Laureates, including the winner of the 2007 Nobel Prize for Medicine, University Chancellor Professor Sir Martin Evans. Founded by Royal Charter in 1883, today the University combines impressive modern facilities and a dynamic approach to teaching and research. The University’s breadth of expertise encompasses: the College of Humanities and Social Sciences; the College of Biomedical and Life Sciences; and the College of Physical Sciences, along with a longstanding commitment to lifelong learning. Cardiff's three flagship Research Institutes are offering radical new approaches to neurosciences and mental health, cancer stem cells and sustainable places.