Physiology

Acute kidney injury (AKI)

Lead investigators: Professor Andrew Davenport, Dr Chris Laing

The Royal Free Hospital is the central hub of the North London Acute Kidney Injury Network. We are currently involved in several clinical projects including biomarker studies in decompensated cirrhosis and post-cardiac surgery and epidemiological and clinical studies in management of patients with AKI and developing novel treatments for patients with acute on chronic liver failure with acute kidney injury.

Renal stone disease

Lead investigators: Dr Shabbir Moochhala, Professor Robert Unwin

We are interested in finding new ways to treat kidney stone disease as the more common forms are becoming increasingly problematic in the UK and worldwide. We are participating in clinical trials into pharmacological treatment for certain calcium stone formers. Some families have a very strong family history of stone formation, and we are looking for genetic causes in these families or using our large DNA biobank to look for patterns in larger groups (collaborations with Renal Genetics group).

We recognise that collecting urine over 24 hours is inconvenient for patients, so we are now trialling new portable infra-red technology to obtain biochemical data quickly and accurately for urine and stones in collaboration with UCL Structural and Molecular Biology.

Glucose and phosphate transport

Lead investigators: Dr Joanne Marks, Professor Robert Unwin

Glucose transport across renal and intestinal cells contributes to body glucose balance and is markedly altered in diabetes mellitus (DM). We aim to elucidate the mechanisms leading to altered intestinal and renal glucose transport in DM. DM accounts for almost 30% of patients developing advanced CKD, so defining the role of altered glucose transport in DM and the relationship to its major renal complication is likely to be important.

The intestine and kidneys are also involved in the regulation of body phosphate balance, which has been linked to premature CVD and vascular calcification in CKD. Phosphate overload occurs in CKD. In the absence of adequate excretion by the kidneys to prevent this, absorption by the intestine becomes an important therapeutic target.

We are investigating the mechanisms of phosphate absorption by the intestine and how they are regulated, particularly by a group of novel hormones called phosphatonins. One in particular, FGF-23, has also been implicated in vascular calcification.

Our experts

Selected Publications 

1. Davenport A. (2023). Calcium balance in peritoneal dialysis patients treated by continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) cyclers. Journal of Nephrology.
2. Davenport A. (2023). Differences in prevalence of reduced and low bone mineral density between lumbar spine and femoral neck in peritoneal dialysis patients using dual-energy X-ray absorptiometry (DXA). PERITONEAL DIALYSIS INTERNATIONAL.
3. Vareesangthip K, Fan S, Davenport A. (2023). Is the measurement of tissue advanced glycosylation products by skin autofluorescence associated with mortality in patients treated by peritoneal dialysis? Journal of Nephrology, 36 (1), 217-224. 
4. Davenport A. (2023). Survey of food offered to United Kingdom haemodialysis patients attending for dialysis sessions in main dialysis centres and satellite units and international comparison. Renal Replacement Therapy, 9 (1), 10.
5. Goodlad C, Davenport A. (2023). The changing pattern of COVID-19 infection in haemodialysis and peritoneal dialysis patients. Artif Organs.
6. Davenport, A. (2023). Why is Intradialytic Hypotension the Commonest Complication of Outpatient Dialysis Treatments? Kidney International Reports, 8 (3), 405-418. 
7. Li Y, Luo L, Davenport A, et al. (2022). A graphene nanoplatelet-polydopamine molecularly imprinted biosensor for Ultratrace creatinine detection. Biosensors and Bioelectronics, 216 
8. Vilar E, Kamal RMK, Davenport A, et al. (2022). A multicenter feasibility randomized controlled trial to assess the impact of incremental versus conventional initiation of hemodialysis on residual kidney function. KIDNEY INTERNATIONAL, 101 (3), 615-625.
9. Davenport A. (2022). Application of the Clinical Frailty Score and body composition and upper arm strength in haemodialysis patients. CLINICAL KIDNEY JOURNAL, 15 (3), 553-559. 
10. Jaques DA, Henderson S, Davenport A. (2022). Association between bone mineral density at different anatomical sites and both mortality and fracture risk in patients receiving renal replacement therapy: a longitudinal study. Clinical Kidney Journal, 15 (6), 1188-1195. 
11. Hendra H, Sridharan S, Farrington K, Davenport A. (2022). Characteristics of Frailty in Haemodialysis Patients. Gerontology and Geriatric Medicine, 8.
12. Guedes M, Vernooij RWM, Davenport A, et al. (2022). Clinical performance, intermediate and long-term outcomes of high-volume hemodiafiltration in patients with kidney failure. SEMINARS IN DIALYSIS, 35 (5), 420-426. 
13. Davenport A. (2022). Comparison Between the Physical Performance Test and the Clinical Frailty Score in Adult Patients With Chronic Kidney Disease Treated by Haemodialysis. Gerontology and Geriatric Medicine, 8 
14. Davenport A. (2022). Comparison of frailty, sarcopenia and protein-energy wasting in a contemporary peritoneal dialysis cohort. PERITONEAL DIALYSIS INTERNATIONAL, 42 (6), 571-577. 
15. Hendra H, Sridharan S, Farrington K, Davenport A. (2022). Determinants of active energy expenditure in haemodialysis patients. Clinical Physiology and Functional Imaging, 42 (5), 303-307.
16. Blair C, Slee A, Davenport A, et al. (2022). Developing an Evidence and Theory Based Multimodal Integrative Intervention for the Management of Renal Cachexia: A Theory of Change. Healthcare, 10 (12).
17. Blair C, Shields J, Mullan R, Davenport A, et al. (2022). Exploring the lived experience of renal cachexia for individuals with end-stage renal disease and the interrelated experience of their carers: Study protocol. PLoS ONE, 17 (11).
18. Davenport, A. (2022). Frailty, appendicular lean mass, osteoporosis and osteosarcopenia in peritoneal dialysis patients. Journal of Nephrology, 35 (9), 2333-2340. 
19. Canaud, B., Davenport, A., Golper, T.A., Raimann, J.G. (2022). Hemodiafiltration in 2022: Introduction to the symposium. Seminars in Dialysis, 35 (5), 377-379.

Funding and Partnerships

The UCL Dialysis & Physiology Centre is one of the partners in the European Horizon 2020 funded CONVINCE trial comparing high volume on-line haemodialfiltration with high flux haemodialysis, and the lead centre for the STITCHED mechanistic study nested within the UK H4RT study, again comparing high volume on-line haemodialfiltration with high flux haemodialysis.