Then and now: the evolution of Lawson's kidney research

Fall 2017

In the 150 years since Canada’s Confederation, Lawson Health Research Institute (Lawson) - the research institute of London Health Sciences Centre and St. Joseph's Health Care London - has achieved numerous national and world firsts in hospital-based research.

One is the development of the first artificial kidney machine in Canada, at LHSC’s Victoria Hospital.

Until the late 1940s, patients diagnosed with kidney failure had no chance of survival.

Dr. Willem Kolff, in Holland, began investigating the prospect of mechanically replicating the kidney’s functions and built two different artificial kidney machines.

Dr. Jacobus van Noordwijk, who had worked with Dr. Kolff, spent a year at LHSC’s Victoria Hospital instructing physicians on how to build and operate an artificial kidney machine.

Scientific accomplishments in the health sector, like the artificial kidney machine, are an important part of our country’s heritage, and they also contribute to the legacy left for future generations.

Now almost 70 years later, we still use a version of the artificial kidney machine – dialysis – to treat patients with kidney failure by removing toxins and extra fluid from the body.

Lawson scientists such as Drs. Chris McIntyre and Amit Garg are working to change the way we treat kidney failure in the future. They are leading a clinical trial that has the potential to reduce the risk of heart attacks and strokes, the leading cause of death among dialysis patients.

Their team has shown that the heart and brain become starved of blood and oxygen during dialysis. About half of patients experience large drops in their blood pressure while receiving treatment, which can lead to dizziness, fatigue, and muscle cramping. Repeated drops in blood pressure can also injure the heart and brain. Over time this may lead to heart attacks, strokes, and sometimes death.

They are now investigating whether personalizing the temperature of dialysis fluid, called dialysate, can protect the heart and brain from injury.

“Typically, dialysate is set to a temperature of 36.5 ºC to match body temperature. However, body temperature can range from 35.5 to 37.5 °C. Research shows that personalizing the temperature of dialysate to 0.5 ºC below the patient’s body temperature can reduce the frequency of large drops in blood pressure,” says Dr. Amit Garg, nephrologist and director of living kidney donation at LHSC.

The study, called My TEMP, will be conducted in all 26 Ontario hemodialysis renal programs. These hemodialysis programs oversee 84 hemodialysis centres participating in MyTEMP and care for more than 7,500 patients. The trial is funded by the Canadian federal and provincial governments, the Ontario Renal Network and the Heart and Stroke Foundation of Canada.

“Previous studies looking at this treatment included a small number of patients and followed them for a short period of time. We don’t know if the treatment is effective in the long run and if providing it to all patients on dialysis will translate to fewer deaths and hospitalizations for heart attacks and strokes. This underscores the need for a larger-scale study with long-term follow-up of dialysate temperature among patients undergoing dialysis three times a week,” adds Dr. Garg.

Aside from initial staff education, personalizing the temperature of dialysis fluid can easily be delivered on any hemodialysis machine at no added cost.

“Every year, over 500,000 patients on hemodialysis worldwide die or are hospitalized because of a major cardiovascular event. If this change in a routine practice for a hemodialysis centre is successful, even a modest 10 per cent risk reduction will result in 50,000 fewer deaths and hospitalizations each year,” says Dr. Chris McIntyre, director of the Lilibeth Caberto Kidney Clinical Research Unit at LHSC, and assistant director of Lawson’s Nephrology Research Program.

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Dr. Amit Garg
1949 Canada's first artificial kidney machine