We would like to collect and test samples from people with cirrhosis who are admitted to our unit to search for new biomarkers of kidney damage and to see if there are differences in these biomarkers between patients who recover fully and those who do not. We hope that this research will lead to a better test for kidney damage that might improve outcomes for people with cirrhosis.
We are undertaking a research study to identify substances that are released into the blood or urine when the kidney is damaged in people with cirrhosis. These substances (so called ‘biomarkers’) might enable us to detect kidney damage more quickly so that appropriate treatment can be started promptly. Acute kidney injury (AKI) is a common and under-diagnosed problem in patients with liver cirrhosis, and is associated with significant illness and preventable death. Blood (serum) creatinine is the current test for kidney function, but it is an insensitive and non-specific marker in cirrhosis. We hypothesise that blood (plasma) levels of kidney injury molecule-1 (KIM-1) will detect AKI earlier and predict the risk of worsening AKI in cirrhosis, thus identifying patients in need of prompt and effective treatment and improving patient outcomes. We will collect blood and urine samples from cirrhosis patients admitted into hospital and study the relationship between plasma KIM-1, other diagnostic ‘biomarker’ tests that have recently been proposed, and patient outcomes.
DASH is a randomised clinical trial investigating a treatment to reverse the effects of blood-thinning medications.
People who develop an Acute Kidney Injury (AKI) often have a poor prognosis and many go on to develop chronic kidney disease (CKD). The recognition that AKI and CKD are linked is recent and the molecular pathways that control the transition from acute injury to chronic disease are not well defined. Currently there are no specific treatments that reduce the risk of progressing to CKD after AKI.
Preliminary investigations (not yet published) suggest that AKI causes sustained activation of the endothelin (ET) system to the long-term detriment of renal and systemic haemodynamic function. These pilot data form the basis of our project that seeks to determine whether the ET system is active in patients with AKI and, thus, represents a potential target for therapeutic intervention.
KRAKIL aims to recruit altogether 100 patients from across the emergency department, acute medical unit and inpatient wards at the Royal Infirmary. 50 of which with AKI’s and 50 matched controls with normal kidney function. We will monitor their bloods and urine for 90 days and compare the data from between the two groups.