NZ dialysis patients are winners in A$25,000 Fellowship

EMBARGO: Tuesday 21 August 2012, 6pm NZT

Media release
21 August, 2012

L’OREAL FOR WOMEN IN SCIENCE AWARD ANNOUNCED
NZ dialysis patients are winners in A$25,000 Fellowship

University of Otago, Christchurch, senior lecturer Dr Suetonia Palmer has been recognised with a A$25,000 (NZ$32,480) Fellowship for her achievements in improving the treatment of people with chronic kidney disease around the world.

Dr Palmer is one of three Australasian women who have each gained a L’Oréal For Women in Science 2012 Fellowship awarded by L’Oréal Australia and New Zealand.

It is the sixth year of the Fellowships and the first year they have been open to New Zealand scientists.

A qualified medical practitioner, Christchurch-based Dr Palmer realised that the information available to doctors and patients is often confusing and sometimes wrong.

So she and her international colleagues have written a series of practice guidelines (Cochrane reviews) that gives doctors the best information.

Dr Palmer will use the Fellowship to help dialysis patients better prepare for treatment so they can treat themselves at home.

“Statistics show us that better prepared patients do better in the long run,” Dr Palmer says. “Patients prefer to treat themselves at home and the cost of doing so is less than half that of hospital treatment.”

“Our focus will be on researching how and when people get their information about treatment options and from this we will be able to develop best-practice guidelines for both patients and their doctors.”

Information will be gathered in interviews, focus groups and from world experience among indigenous and non-indigenous patients and their families in New Zealand.

Kidneys clean our blood. But about 10 per cent of the population will develop kidney disease and enter a lifelong process of disease management. A major cause of kidney disease is diabetes and indigenous people are three-times more likely to need dialysis treatment and less likely to receive a transplant, Dr Palmer says.

“There is a need to raise awareness of kidney disease among the general population, doctors and policy makers and I believe our research will go a long way to provide new access to the best information.”

She says that while dialysis patients learn how to home treat themselves in only a few weeks it is a daunting prospect for most.

“So proper training is essential. There’s a big scary machine and patients need to put needles in their arms and it can be overwhelming to some. The L’Oréal Fellowship will advance our research programme because we first need to know what information people are getting, when it is given and how effective it is.

“My wish is that over the next decade we can give back control of their lives to dialysis patients – so they can be in charge of their own treatment, get back to work and make them feel better.”

Dr Palmer works from temporary facilities in the Christchurch campus of the University of Otago while the city rebuilds. The Garden City is unusual in that historically it has been a leader in kidney disease self-treatment at home so it’s an ideal location to develop the research.

The other two L’Oreal For Women in Science 2012 Fellowships have been awarded to Dr Baohua Jia and Dr Kylie Mason both from Melbourne. Dr Jia is researching more efficient solar cells while Dr Mason, is researching new treatments for blood cancers.

Ends

ABOUT L’ORÉAL UNESCO For Women In Science
For the past 14 years, the L’Oréal Corporate Foundation and UNESCO have supported women researchers throughout the world who contribute to moving science forward. Each year, the For Women in Science Programme highlights scientific excellence and encourages promising talent.

Since 1998, the L’ORÉAL-UNESCO Awards have recognised 72 Laureates, exceptional women who have made great advances in scientific research. Two of them have gone on to receive the Nobel Prize.

In its aim to promote and encourage women throughout their scientific careers, the For Women in Science partnership has also developed a global network of International, Regional and National Fellowship programs aimed at supporting young women who represent the future of science.

To date, Fellowships have been granted to more than 1,200 women in 103 countries, permitting them to pursue their research in institutions at home or abroad. The programme has become a benchmark of scientific excellence on an international scale. www.forwomeninscience.com

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L’Oréal Australia and New Zealand For Women in Science Fellowships 2012 citations

Embargoed to 5 pm Tuesday, 21 August 2012

Giving patients more control of their lives

Suetonia Palmer, University of Otago, Christchurch, New Zealand

Dr Suetonia Palmer is challenging the status quo for kidney disease treatment and helping millions of people with chronic kidney disease take back control of their lives.

Working from temporary facilities as Christchurch rebuilds, she is guiding doctors and policy makers across the world as they attempt to make the best decisions for their patients.

Kidneys clean our blood, remove toxins, make vitamins and much more. But more than ten per cent of us will develop kidney disease and enter a lifelong process of disease management.

Suetonia realised that the information available to doctors and patients is often confusing and sometimes wrong.

She’s changing the lives of people with kidney disease by making sure they and their doctors have access to the best information via a series of Cochrane reviews that take millions of bits of information and turn them into best practice guidelines.

Her 2012 L’Oréal For Women in Science Fellowship will take her work further and help her study what information people receive when their kidney disease worsens and they have to go on dialysis. That usually requires four hours a day, four days a week in hospital. However in Christchurch most people have dialysis machines at home. Suetonia will determine what is best practice.

“I believe we can do much more to help people with kidney disease feel better, get back to work, and give them control of their own treatment,” she says.

When Suetonia started training as a junior doctor she had the opportunity to work in the kidney unit in Christchurch. There she developed a deep appreciation of the work our kidneys do. “The kidney is a remarkable organ. Apart from the simple tasks of filtering and cleaning blood, it makes all sorts of important compounds such as erythropoietin (EPO) which manages red blood cell production. And they probably perform all sorts of jobs that we haven’t discovered yet,” Suetonia says.

“When our kidneys go wrong the early signs are usually silent, we get tired, our blood pressure increases, we become anaemic, and we can just feel awful. Unfortunately when people get kidney disease it’s usually for life. They live with the disease. I realised that my role was to be part of their journey, helping them feel as good as they can be and as informed as they can be.”

Suetonia found working with a patient over months or years was incredibly rewarding. But she also realised that the information available to doctors and patients about kidney disease was confusing and sometimes contradictory. She set out to change that.

Today she spans the gap between research and the clinic as a senior lecturer in the Department of Medicine at the University of Otago in Christchurch

“Working in the clinic I realised that some of the treatments used every day may be less effective than we think they are and that some of the tools we use to track disease progress may not really do the job we need.”

So Suetonia set about reviewing the best practice from around the world and writing it up in a series of Cochrane Reviews on kidney disease.

Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care.

“A Cochrane review answers the question, ‘How do you know if one treatment will work better than another, or if it will do more harm than good?’” says Suetonia.

Suetonia has become an editor for the Cochrane Renal Group, working with colleagues in Sydney, Brisbane, Italy and Canada. Each review is prepared by an 'author team' with support from specialist librarians, methodologists, copy and content editors, and peer reviewers, taking hundreds of hours of work from start to finish.

As a result of their work doctors don’t have to hunt around the internet for the latest trial information. “We’ve compiled all the evidence and present the best options. Doctors around the world can make better decisions using the Cochrane information.”

But the reviews have also confirmed her concerns. She and her colleagues have found for example that:

• kidney drug trials are often flawed because they use indirect measures such as blood levels of phosphorus, cholesterol, and haemoglobin that may not accurately indicate if the drug is having an impact on clinical outcomes such as heart disease and death;

• relying on these flawed markers may cause harm because of the unexpected adverse consequences of treatment;

• many drugs are routinely used in people with advanced kidney disease including erythropoietins; statins; antiplatelets; vitamin D; phosphate-lowering drugs, but there’s little evidence that they do any good;

• that patients rate the information they receive about healthcare as incomplete or inaccurate.

“Given the relative lack of treatments shown to improve health outcomes in people with advanced kidney disease, I believe we need to refocus research on the patient experiences of living with kidney disease and rethink our approach to the methods we use to test new healthcare interventions,” she says. And that will be the focus of her L’Oréal Fellowship.

Suetonia and her colleagues are now focussing on gaps in the literature where there is little information on best practice. This includes comparing home versus hospital dialysis, and patient experiences of healthcare, oral disease, depression, and sexual dysfunction. They are also working to better understand the needs and expectations of patients when they learn that they have kidney disease or need dialysis or kidney transplantation.

The Christchurch earthquakes have been an additional complication for her work. “It has affected us all – our patients on dialysis had to leave town because of the lack of reliable water and power, the medical school’s main building has been closed for repair, and our dialysis centre will have to be taken down,”she says.

But she’s not leaving town herself, “Christchurch has a rich research community with strong collaborations. It’s a friendly collegial place to do good work.”

Qualifications

2010 PhD (Medicine), University of Otago, New Zealand

1995 Bachelor of Medicine and Bachelor of Surgery, University of Otago, New Zealand

Career highlights, awards, fellowships, grants

2011-present Senior Lecturer, Department of Medicine, University of Otago, Christchurch, New Zealand

2012 Best poster, 49th ERA-EDTA Congress, Paris, France, European Renal Association-European Dialysis and Transplant Association

2011 Health Research Council of New Zealand Program Grant extension (years 4-6), “Neurohormonal and genetic prediction and protection in heart disease

20092010 Postdoctoral Fellowship, Renal Division, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA

2009 & 2010 Don and Lorraine Jacquot Fellowship, Royal Australasian College of Physicians

2008 Best Presentation, Annual Scientific Presentations, Health Research Society of Canterbury, New Zealand

2008 Travelling Scholarship to American Society of Nephrology Renal Week, Philadelphia, USA, Australia and New Zealand Society of Nephrology

2007-2008 National Heart Foundation of New Zealand grant, “Regional secretion and clearance of novel peptides in health and heart disease”

20062008 PhD candidate and Health Research Council of New Zealand Clinical Research Training Fellow, Department of Medicine, University of Otago, Christchurch

2006-2008 Canterbury Medical Research Foundation grant, “Renal impairment in decompensated heart failure”, awarded to Richards M., Palmer, S., Endre, Z., Yandle, T.

2006-2008 National Heart Foundation of New Zealand grant, “Renal impairment in decompensated heart failure”

2006 Jacquot Research Entry Scholarship, Royal Australasian College of Physicians [declined]

2006 Clinical Research Training Fellowship, Health Research Council of New Zealand

2005 Fellow, Royal Australasian College of Physicians

2004 Bruce Morrison Prize for best presentation, Annual Scientific Meeting, New Zealand Nephrology Group

2003 Dr Jack Kilpatrick Memorial Prize for Best Clinical Presentation at Medical Staff Rounds, University of Otago, New Zealand

20012005 Royal Australasian College of Physicians Advanced Training Fellow, Departments of Nephrology at Christchurch and Dunedin Hospitals, New Zealand

19992000 Royal Australasian College of Physicians Basic Training Fellow, Departments of Medicine, Christchurch and Dunedin Hospitals, New Zealand

1998 Senior House Officer, Accident and Emergency Department, Dryburn District General Hospital, Durham, United Kingdom

Top five publications

Palmer S.C., Hayen A., Macaskill P., Pellegrini F., Craig J.C., Elder G.J., Strippoli G.F.M. (2011) Serum levels of phosphorus, parathyroid hormone, and calcium and risks of cardiovascular death and cardiovascular disease in individuals with chronic kidney disease: A systematic review and meta-analysis, Journal of the American Medical Association 305(11):1119-1127. (Impact factor 30.0, 22 citations)

Palmer S.C., McGregor D.O., Macaskill P., Craig J.C., Elder G.J., Strippoli G.F. (2007) Meta-analysis: Vitamin D compounds in chronic kidney disease, Annals of Internal Medicine 147(12):840-53. (Impact factor 16.7, 96 citations)

Palmer S.C., Navaneethan S.D., Craig J.C., Johnson D.W., Tonelli M., Garg A., Pellegrini F., Ravani P., Jardine M., Perkovic V., Graziano G., McGee R., Nicolucci A., Tognoni G., Strippoli G.F.M. (2010) Meta-analysis: Erythropoiesis-stimulating agents in people with chronic kidney disease, Annals of Internal Medicine 153(1):23-33. (Impact factor 16.7, 29 citations)

Palmer S.C., Di Micco L., Razavian M., Craig J.C., Perkovic V., Pellegrini F., Copetti M., Graziano G., Tognoni G., Jardine M., Webster A., Nicolucci A., Zoungas S., Strippoli G.F. (2012) Effects of antiplatelet therapy on mortality and cardiovascular and bleeding outcomes in persons with chronic kidney disease: A systematic review and meta-analysis, Annals of Internal Medicine 156(6):445-59. (Impact factor 16.7, 0 citations)

Palmer S.C., Yandle T.G., Frampton C.M., Troughton R.W., Nicholls M.G., Richards A.M. (2009) Renal and cardiac function for long term (10-year) risk stratification after myocardial infarction, European Heart Journal 30(12):1486-94. (Impact factor 9.8, 2 citations)

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Backgrounder disease – 1
Date 21 August 2012

Incidence of Kidney Disease in New Zealand
(2009 figures in brackets) [Source: kidneys.co.nz ]

• As at Dec 31 2010 there were 2,378 (2,260) people on some form of dialysis. 53% (51%) were treated with some form of Home dialysis of which 68% was peritoneal dialysis
• In New Zealand there was a 14% increase in new patients in 2009 after a 7% increase in 2008 and a 7% decrease in 2007. The number of new patients in 2010, 503 (567)
• Of these 861 were Caucasian, 723 were Maori, 485 were Pacific people, 180 were Asian with 11 other.
• There were 503 (567) new patients who commenced some form of renal replacement therapy in 2,010
• Over the period since 1990 the number of people in New Zealand receiving Renal Replacement therapy has increased by 6.9% per year
• Although the success of kidney transplantation is improving all the time the number of kidney transplants is a limiting factor. The number of transplants from deceased donors has remained static for the last 10 years. There has been an increasing number of kidneys from living donors, particularly living unrelated donors in recent years. There have been 31 kidneys transplanted from altruistic donors in New Zealand since 1998.
• There has been a change in the types of kidney disease to which the end-stage kidney failure is attributed. In particular, the bulk of the increase has occurred in people with diabetic nephropathy and kidney disease related to hypertension and renovascular disease, such as glomerulonephritis
• For both Australia and New Zealand, the incidence rates since the Registry commenced have increased steadily since commencement of renal replacement therapy (RRT=dialysis and transplantation).

Additional information:
• Diabetic nephropathy (51%) was the most common cause of End Stage Renal Disease followed by glomerulonephritis (22%) and hypertension (12%).
Diabetes Type II (non-insulin and insulin requiring) represented 95% of diabetic nephropathy.
• The number of Maori and Pacific People starting dialysis decreased in 2010 (152 patients and 106 patients) respectively. 47 Maori patients commenced on PD in 2010 while the number of Pacific People starting PD increased from 2009 (28/22).
• In New Zealand the mean age of patients commencing dialysis is 58.3 yrs and the median is 60.3 years
• There are 689 patients waiting for a kidney transplant in New Zealand
• Of the incident diabetic patients, 113 patients (44%) were Maori, 73 patients (29%) were Pacific People, 49 patients (19%) were Caucasoid and 21 patients (8%) were of other ethnicity.
• The number of prevalent Maori with treated end-stage kidney disease rose by 4% whilst Pacific People increased by 11% in 2010.

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