Hemmelgarn, Dr. Brenda

2017 Finalist: ASTech Awards

Taking two-fold approach to preventing Chronic Kidney Disease progression

Chronic kidney disease (CKD) affects approximately 10 per cent of the adult population in Canada. The most common cause of CKD is diabetes, followed by high blood pressure and various inherited conditions. Preventing the progression of CKD is critical as it can lead to kidney failure and death.

“Life is not sustainable without kidneys. If the kidneys fail, treatment options are either a kidney transplant, if patients are eligible, or else some form of renal replacement therapy such as hemodialysis,” explained Dr. Brenda Hemmelgarn, department head of Community Health Sciences at the University of Calgary and a clinical nephrologist.

The dire nature of CKD drives Dr. Hemmelgarn to focus her research into improving the care and outcomes of patients with CKD to ensure the prevention of kidney failure. With such a large number of patients affected by this disease, Hemmelgarn’s work has had an astounding impact in Alberta, Canada and internationally.

Addressing the gaps

Hemmelgarn points out that approximately 95 per cent of patients with early stage kidney disease are treated in primary care settings. “As kidney doctors we only see about five per cent of the more severe cases,” she said. As a result, much of the expertise doctors like Hemmelgarn develop is reserved for fewer patients and many living with kidney disease aren’t receiving the specialized treatment they require.

“There has been a lot of evidence recently about effective management of patients,” said Hemmelgarn. “We know that there are effective strategizes for care, blood pressure control and blood sugar control and special types of medications known as ACE inhibitors.” Angiotensin-converting enzyme (ACE) inhibitors help relax blood vessels.

Despite the current research findings, Hemmelgarn said their data sources across the province identified gaps in care where patients with CKD, who could potentially benefit from those strategies and therapies, are not receiving the care. Hemmelgarn’s research focuses on the assembly of a large cohort of information on patients across the province with kidney disease. Using this data she was able to determine that the amount of protein in a simple urine test is one of the best predictors of the progression of kidney disease. Also using this data source she was able to identify evidence-practice gaps.

“We know the evidence about proper management that could help slow progression of kidney disease and prevent kidney failure and dialysis,” said Hemmelgarn. “We are working to recognize where those gaps are and help improve them.”

Developing a pathway

From the research into the predictors of proteinuria, Hemmelgarn has since incorporated her discovery into international guidelines for care of patients with kidney disease. Although creating these guidelines was a big step forward, the uptake by practitioners was lacking.

“What [the practitioners] told us repeatedly was that a clinical pathway would be optimal in their clinical setting where they could access the information online quickly when they had a patient in front of them to help them better understand how to manage patients with kidney disease,” Hemmelgarn said. From this feedback, Hemmelgarn developed an online tool called the Chronic Kidney Disease Clinical Pathway, which has greatly increased the uptake of the evidence into primary clinical practice.

This work has also lead to the establishment of the Alberta Kidney Disease Network, which is a collaboration of nephrologists and nephrology researchers from across the province with the goal of studying clinical outcomes and improving care for patients with chronic kidney disease.

Hemmelgarn explained the network has become a “novel data source of over four million individuals recognized internationally because of the research and data holdings that we have. A number of other provinces and other countries around the world have now established similar data holdings and data sources to better understand how services, research and delivery of care affects patients with CKD.”

By understanding the current practice, researchers are able to affect and change programs and the delivery of care. This body of work is driven by the patients in order to improve the quality of life for patients living with kidney disease.

“Ultimately what we want to do is to prevent development of kidney failure. It’s a huge transition in anyone’s life when they are on hemodialysis and have to go to a hospital three times a week, four hours each time, to get dialysis to clean the blood to sustain life,” said Hemmelgarn.

Now, Hemmelgarn’s fundamental research is increasingly involving research questions posed by the patients.

“What we’ve found is the questions that are important to the patients are very different than the ones that the investigators think are important. We really are incorporating the patients at all levels of our research: they really are our partners now and it’s the patients who really are the motivating factor.”