Belfast Trust

Government Agency (Health and Adult Social Care)

Dr Michael Patrick Toal

Yes

E081

IgA Nephropathy (IgAN) is one of the most common forms of kidney disease worldwide and frequently causes kidney failure, particularly in younger people with an average age of 45 years old at diagnosis. This condition is diagnosed by taking a biopsy sample from the kidney and looking at it under a microscope. This project aims to improve methods of identifying patients with IgAN who are at the highest risk and treating them earlier, to prevent their disease progressing to kidney failure which is associated with an increased risk of death. We will examine the current methods of estimating the risk of kidney failure based on patient characteristics, the results of blood and urine tests and information gained by kidney biopsy examination. We will investigate which strategy has the best ability to identify patients at the highest risk in a Northern Ireland population and if timely treatment is cost-effective. Identifying the highest risk group and starting intensive treatment could reduce the rates of kidney failure and the requirement of expensive treatment such as dialysis and/or kidney transplantation. We will explore what barriers exist to performing a kidney biopsy and how these can be overcome. This will be assessed in a detailed online questionnaire for an audience of specialists involved in providing patient care in Northern Ireland and across the world. We aim to assess the costs of managing patients with IgAN and estimate how much money could be saved with more timely identification and treatment with medication, therefore reducing the use of expensive therapies for kidney failure such as dialysis and transplantation. Overall this project aims to improve the care of people living with IgAN by identifying and treating the highest risk patients to prevent kidney failure, reduce healthcare expenditure and preserve quality of life.

I intend to perform a comprehensive retrospective analysis of a disease cohort that has never been studied in Northern Ireland, yet is responsible for a significant health and economic burden. I aim to highlight the growing health burden of CKD due to IgAN and the challenges of managing this condition on an individual and societal level. Currently available prognostic models in IgAN are limited and I aim to improve the accuracy and specificity of these models. The science and psychology of clinical decision-making and risk aversion is an understudied area, yet is vitally important to understanding the human factors contributing to the delivery of safe and effective healthcare. In particular, there is limited data on varying clinician behaviours and attitude to renal biopsy, a vital investigation in the field of nephrology. The economic impact of ESRD is well established, but active strategies to reduce progression of CKD are vital to reduce the financial burden.

24/11/2022

TRE