Research themes

Chronic kidney disease (CKD) is a common condition affecting ~8-14% of the population, increasing with older age. In its most severe form (where the kidneys function very poorly) life is unsustainable and death is inevitable unless renal replacement therapy (RRT) in the form of dialysis or with a transplanted kidney is undertaken. These have impacts on the quality of patients’ and their loved ones lives, and are expensive.

CKD in its less severe forms is associated with other poor outcomes including increased risk of death, cardiovascular disease and complications such as anaemia and bone disease. Earlier identification of CKD is thought to allow the earlier management of the disease process and therefore stop or reduce progression of the disease. However not all patients get worse, and many find very frequent visits to see a kidney specialist difficult.

In Grampian we are researching what factors about patients with CKD might predict those who will do well and those who won’t do so well. This is so that the level of care that patients receive could be matched to their likely outcomes and therefore healthcare needs and interventions.

Acute kidney injury (AKI) is a serious, widespread and costly condition. It complicates 1 in 7 hospital admissions and costs NHS England £1.2 billion per year. It is a rapid deterioration of kidney function, usually identified by a change in blood results.

Though serious, AKI is often poorly recognized and inadequately managed. It is also unclear who is at greatest risk of long term health problems. This makes it hard to provide clear guidance for clinicians and patients and policy-makers.

We have an established cohort of patients with kidney disease using data linkage in Grampian. We are using it to explore:

• How can AKI be identified in routine healthcare?
• What is relationship between AKI and chronic kidney disease?
• Why do some patients do better than others?
• Can we predict who develops long term health problems after AKI?

We develop study cohorts that utilise routine healthcare data and linkage to special data collections to facilitate the study and follow up of patients with kidney disease. Methodological developments from this theme have developed as a natural part of the process.

Current Projects

• Multi-morbidity
• Medications
• Vasculitis

Establishing linkages and study cohorts

• Grampian Laboratory Outcomes Morbidity and Mortality Study (GLOMMS)
• Grampian Renal Biochemistry Dataset (GRBD)
• Aberdeen Maternity Neonatal Data-GRBD linkage
• Child Medical Records for Safer Medicines (CHIMES)
• Health and Chronic disease across life

Methodological work

• Recording of comorbidities and application in administrative data
• Application of medication adherence measures in chronic disease
• Detecting adverse drug reactions in routine data
• Use of Scottish Prescribing Information System (PIS) in research