2011

Dr. Kara Schick Makaroff, Ph.D.
University of Alberta
Supervisor: Dr. Anita E. Molzahn

KRESCENT POST-DOCTORAL FELLOWSHIP 2011-2015

Dr. Schick Makaroff is a registered nurse who will pursue her post doctoral fellowship under the supervision of Dr. Anita Molzahn in the Faculty of Nursing at the University of Alberta in Edmonton.  Dr. Schick Makaroff completed her Ph.D. at the University of Victoria and she was partially funded by The Kidney Foundation of Canada. She is interested in studying health-related quality of life from the perspective of people affected by kidney disease in order to improve provision of care to this population. For instance, the treatment of end-stage renal disease (ESRD) is complex and involves dialysis or transplantation, diet restrictions, medication, exercise, and numerous medical appointments. It is important to consider individuals’ perspectives of the quality of their lives and health status in light of the changes they have encountered and this can only be assessed by the patient. Caring for patients with ESRD provides an opportunity for nurses to fully consider patients’ experiences of illness in relation to their quality of life. Such assessments may provide necessary and often missing information for nurses to support patients and manage their care. The purpose of the project is to evaluate the results of measuring patients’ health related quality of life through questionnaires using computer-based technology. Findings will offer information for nurses and other healthcare professionals who work with people living with ESRD to support them in managing their illnesses, reduce the burden of kidney disease, and enhance their quality of life.

Dr. Marie-Chantal Fortin is a new investigator at the Centre hospitalier de l'Université de Montréal. She obtained her MD from the Université de Sherbrooke and completed a Post-Doctoral Fellowship, funded by The Kidney Foundation of Canada, the Canadian Society of Transplantation and the Institute of Immunity and Infection of the Canadian Institutes of Health Research, with Dr. Hubert Doucet at the Université de Montreal. O blood group recipients are at a disadvantage in kidney exchange programs (EPs) since they can only receive organs from O donors, whereas the latter are universal donors. One way to remedy this situation is to offer all O blood group donors compatible with their non-O recipients an opportunity to participate in an EP. This approach raises important ethical issues, particularly concerning the fairness of allocation procedures. Our research project aims to document the perspectives of stakeholders (transplant professionals, referring nephrologists, pre-dialysis nurses and donor/recipient compatible pairs) regarding the possible participation of compatible pairs in EPs, and to develop preliminary ethical guidelines in this area.

Dr. Lakshman Gunaratnam is a new investigator at the University of Western Ontario. He obtained his MD from the University of Ottawa and then completed his Post-Doctoral Fellowship, funded by the KRESCENT Program, with Dr. Joseph Bonventre at the Brigham and Women’s Hospital in Boston. Dr. Gunaratnam also received his clinical training in nephrology and transplantation at Harvard Medical School. The focus of his research program is acute kidney injury (AKI), which affects about 5% of all hospitalized patients. Despite considerable advances in diagnosis and management of AKI, the high mortality rates associated with severe AKI remain largely unchanged. AKI is most often caused by circulatory collapse resulting in reduced blood supply to the kidney (ischemia) that leads to widespread death of kidney epithelial cells. The rapid removal of dead cells occurs through a process known as "phagocytosis" that is vital to preventing further inflammation and hastening tissue repair. Recent advances suggest that surviving kidney epithelial cells express KIM-1, a gene product that enables surviving kidney epithelial cells to clear dead or dying cells from the injured kidney by phagocytosis. Dr. Gunaratnam’s research aims to understand the complex cell signalling pathways that govern how KIM-1 enables kidney epithelial cells to mediate phagocytosis. His laboratory hopes to develop novel strategies to enhance this inherent (KIM-1 dependent) kidney protective mechanism to improve clinical outcomes in patients with AKI.

Dr. Juliet Ho is a new investigator at University of Manitoba. She obtained her MD from the University of Western Ontario. Kidney transplantation is one of the therapies to replace the loss of kidney function. Kidney transplantation offers better life expectancy and improved quality of life compared to dialysis. Due to immunosuppressant drug therapies the life expectancy is quite good over the short term. However, when a transplanted kidney fails the return to dialysis is associated with lower quality of life, sensitization, costs and a decreased life expectancy. Chronic kidney transplant injury is the leading cause of transplant failure. 60-80% of the patients with chronic transplant kidney injury develop progressive scarring of the kidney from potentially treatable causes. The goal of Dr. Ho’s project is to develop non-invasive urinary diagnostic tests to identify patients at risk of developing kidney transplant scarring early in the course of their injury. Proteomic techniques will be used to identify novel urinary proteins that may indicate specific reasons for the scarring. Patients at risk for kidney scarring can then be targeted for monitoring and therapy to prevent the progression of the injury.

KRESCENT NEW INVESTIGATOR AWARD 2011-2014
Cofunded with CCHCSP

KRESCENT INFRASTRUCTURE SUPPORT 2011- 2012

Dr. Susan Samuel is a new investigator at University of Calgary. She obtained her MD from the University of British Columbia. Dr. Samuel’s research program looks at children with kidney disease. She is especially interested in the factors that cause death and disability among children with kidney failure. Children with kidney failure are 30 times more likely to die than healthy children. In order to provide children with kidney failure the best chance for survival, we need to identify patient related and health care system related risk factors for death and disability and identify groups of children who are at highest risk for death and disability. The information she will collect and analyse will be used to inform future studies, and guide testing of strategies to prevent death and disability. As part of her research she will also study a difficult time in the life of a person with childhood onset kidney disease: the period of transition from childhood to adulthood and transfer of medical care from child-oriented to adult-oriented healthcare services. It is thought that this transition period is dangerous because teenagers in general may engage in risk taking behaviour such as refusing to take medicines, come to clinic appointments or seek medical attention at the appropriate time. Her project aims to measure the danger associated with this transition period by looking at key variables to indicate danger such as intensive care unit hospital admissions. The information obtained from this research study will inform healthcare practitioners who care for patients with childhood onset kidney failure regarding the best time to transfer a teenage patient to adult-oriented healthcare services and it will help us determine whether extra support is needed after transfer to adult hospitals for these patients.

Dr. Michael Walsh, M.D.
McMaster University

Dr. Michael Walsh is a new investigator at McMaster University. He obtained his MD from the University of Calgary. He completed his Post-Doctoral Fellowship, funded by the KRESCENT Program, with Dr. David Jayne at Addenbrooke’s Hospital in Cambridge (U.K.) and Dr. Philip Devereaux at McMaster University. Annually, 2 million patients worldwide (30,000 Canadians) undergo heart surgery. Although this procedure can be life saving, 1 in 20 patients will not survive their hospital stay. Sudden kidney, heart and brain injuries that occur during surgery are important causes of death after heart surgery and patients with kidney disease are at particularly high risk for all of these injuries. Remote ischemic preconditioning involves the inflation of a tourniquet or blood pressure cuff on the thigh to briefly stop blood flow. This activates the body's own protective systems that can prevent damage to the kidneys, heart and brain. Preconditioning is a promising and simple treatment but there are no studies large enough to determine whether RIPC improves the outcomes most important to patients (e.g. survival). Dr. Walsh will perform a very large study of several thousand patients from around the world that will determine if Remote Ischemic Preconditioning reduces severe kidney injury, heart attacks, strokes or death in patients undergoing heart surgery. The study is called the Remote IscheMic Preconditioning in cArdiaC surgery Trial (Remote IMPACT).

Kidney failure has been a major health problem around the world. Increasing the number of patients and lacking the number of transplants are two main issues. Dialysis technologies continue to play an important role in health care delivery over 65 years. In average, patients having renal failure are required to visit a dialysis center for 4-6 hours, 3 times per week to remove toxins and waste from their blood. A compact and reliable wearable artificial kidney that can be carried by the patient 24 hours a day, 7 days a week will possibly change the quality of the lives of such patients and will assist them to have a normal life. This research project is focused on the design, fabrication and characterization of a compact wearable artificial kidney based on nanotechnology. Nanotechnology is the science of making tiny structures as small as atoms and molecules. With advances in nanotechnology, membranes with precise pore size have been produced. We employ such membranes in our wearable kidney to filter out molecules of toxins and waste from blood more efficiently. Results of this research project may have a great impact on the lives of patients who depend on dialysis.

Theone Paterson holds a masters degree from Simon Fraser University, and is currently in a PhD in Clinical Psychology at Simon Fraser University under the supervision of Drs. Wendy Loken Thorton and R. Jean Shapiro. During her masters degree she studied the relationships between traditional cognitive measures, depressive symptoms and medication adherence in renal transplant patients.