BCRG (Birmingham Cardio-Renal Group)

IMG_2102scaledGroup leaders: Professor Jonathan N Townend, Professor Charles J Ferro, Dr Richard P Steeds and Dr Nicola C Edwards

Overview

The broad theme of the current work is to characterise the structural and functional deterioration within the heart and arterial tree affecting patients with early stage CKD and assess pharmacological methods of improving outcomes.

Our research group

Chronic kidney disease (CKD) as determined by a reduced glomerular filtration rate (GFR - a measure of kidney function) affects up to 15% of the western population, including more than 45% of those aged over 70 years. Studies of patients with even mild CKD show that they are at increased risk of heart failure, stroke and sudden cardiac death with a graded association with reduced GFR. The reasons for these adverse effects on cardiovascular health are not clear. Our research aims to determine what causes these damaging processes and then to establish methods of treatment. 

Previous research

The original Chronic Renal Impairment in Birmingham (CRIB) study was published in 2003, documenting the relative lack of importance of traditional risk factors in CKD. Since this the BCRG have demonstrated abnormalities of vascular and ventricular function in patients with early stage CKD and gone on to design potential therapeutic strategies. In the randomised controlled trial CRIB-2, we investigated the effect of treatment with spironolactone, a mineralocorticoid receptor blocker (MRB), in combination with ACE inhibitors and or angiotensin receptor blockers in patients with early stage CKD. Previously considered to be contra-indicated in CKD, spironolactone was shown to improve prognostically important indices including arterial stiffness and left ventricular (LV) mass with improvement in markers of LV diastolic and systolic function. 

Current projects

The results of CRIB-2 prompted the development of further studies which are currently in progress:

  1. Spiro-CKD

    The SPIRO-CKD trial of spironolactone versus chlorthalidone in early stage CKD has been awarded a British Heart Foundation special project grant. The multi-centre study led by the BCRG should demonstrate the effects of MRB therapy on LV mass and arterial stiffness in this population, independent of changes in blood pressure. The study is currently in follow up and provisional results are eagerly anticipated at the end of 2017. 

  2. CKD-Fibrosis

    CKD-Fibrosis has been awarded a project grant from the British Heart Foundation and uses the very latest in cardiac MRI sequences to elucidate the role of myocardial fibrosis in the pathogenesis of CKD-related heart failure and sudden death. We are still actively recruiting patients with all stages of CKD and patients who have been transplanted. 

  3. CRIB-DONOR II

    Kidney donors provide a unique population without underlying disease and this allows the longitudinal study of an isolated reduction in renal function on the heart and vasculature. A comprehensive pathophysiological study of living kidney donors was previously funded by a British Heart Foundation Fellowship (CRIB-DONOR). The results indicate that living kidney donors have a small increase in left ventricular mass post nephrectomy. We have been recently awarded a second British Heart Foundation Fellowship to follow these patients up again after five years. Recruitment is about to commence. 

  4. EARNEST

    Meanwhile, a less detailed but larger scale UK multi-centre study (EARNEST) of kidney donors has also received a project grant from the British Heart Foundation and involves a number of other UK transplant centres including Cambridge, Glasgow, Bristol, Manchester, Sheffield, St George’s London and Coventry. Over 400 patients have been recruited. Provisional results are anticipated in the next few months.

Recent publications

For full list of publications:

Staff

Principal Investigators

  • Professor Jonathan N Townend, Honorary Reader in Cardiology and Consultant Cardiologist
  • Professor Charles J Ferro, Honorary Reader in Nephrology and Consultant Nephrologist
  • Dr Richard P Steeds, Honorary Senior Lecturer and Consultant in Cardiac Imaging 
  • Dr Nicola C Edwards, Consultant in Cardiac Imaging
  • Dr Davor Pavlovic, Lecturer in Cardiovascular Science
  • Dr Melanie Madhani, Lecturer in Cardiovascular Science

Postdoctoral Researchers

Dr Victoria Stoll, Clinical lecturer and SpR in Cardiology

PhD Students and Clinical Research Fellows

  • Dr Manvir K Hayer, Clinical Research Fellow and SpR in Nephrology
  • Dr Anna M Price, Clinical Research Fellow and Spr in Nephrology 

Former Group Members

  • Dr Colin D Chue, Clinical Research Fellow and SpR in Cardiology
  • Dr Khai Ng, Clinical Research Fellow and SpR in Nephrology
  • Dr William E Moody, Clinical Research Fellow and SpR in Cardiology