Protecting the kidneys during chemotherapy – a new approach

25 July 2025

Dr Mark Devonald from University Hospitals Liverpool received a David Thompson Award of £180,000 jointly funded with the Thompson Family Charitable Trust. Mark and his collaborators will look at whether novel urine tests could identify kidney damage early in patients with cancer receiving chemotherapy, allowing prompt diagnosis and intervention.

The problem

Acute kidney injury (AKI) is a sudden decline in kidney function, that is usually temporary but can lead to permanent kidney damage and is common in hospitalised patients. Some types of chemotherapy, used to treat cancer, can cause AKI. Usually, AKI is detected with a blood test to measure creatinine, a commonly used marker of kidney function. High creatinine levels indicate reduced kidney function. However, creatinine can take over 24 hours to become abnormal after kidney damage, delaying detection and possible interventions to prevent AKI.

Chemotherapy and kidney health

Certain types of chemotherapy, such as cisplatin and ifosfamide, are known to be toxic to kidneys, and just over a quarter of patients develop AKI following cisplatin treatment. However, these drugs are the most effective available treatment for certain types of tumours, so have an important role and are still widely used.

The solution

This project builds on Mark’s previous work with his collaborator Professor David Gardner, in Nottingham. They identified some new markers that increased in urine in an experimental model of kidney injury. They then confirmed that these biomarkers could detect AKI early in two groups of patients at high risk of AKI: patients undergoing heart surgery and patients admitted to a hospital intensive care unit.

Mark and David will work with cancer specialists (Nasim Ali and Ivo Hennig), specialist pharmacist Rob Challoner, consultants Dr Shahed Ahmed and Dr Harsha Wodeyar, renal registrar Dr Catherine Russell and other researchers, to investigate whether these AKI markers are also effective at detecting AKI in patients receiving cisplatin or ifosfamide-based chemotherapy. Creatinine will also be measured in blood samples from these patients over several months to identify any short- or long-term kidney damage.

What could this mean for kidney patients?

If this research shows that kidney damage can be identified earlier by these urine tests than the standard blood test, this could inform future studies which would involve changing the treatment of those patients with positive urine tests to reduce their risk of developing AKI. For example, changing the dose and frequency of the chemotherapy drug, avoiding other drugs that may damage the kidneys further, changes to the amount of fluid given, closer monitoring of kidney function between courses of chemotherapy and referral to kidney specialists earlier. These measures could help to improve kidney health in this group of high-risk patients.

"It is important to increase understanding on the impact of certain medications and chemicals on kidney health and we are really pleased to be supporting this project. Research like this could help detect kidney problems earlier in chemotherapy patients allowing earlier interventions to protect the kidneys and prevent patients who are already suffering from one condition from this leading into another. As a family we know how much impact this can have not only on the patient but on their loved ones around them and we feel that this research is vital to understand this complex subject.” Katie Woodward, daughter of the late David Thompson.

Dr Mark Devonald

Meet the researcher

“We are very grateful to Kidney Research UK and the Thompson Family for this David Thompson Award and hope that this project will demonstrate that these simple markers in urine can enable earlier detection of AKI in patients receiving chemotherapy. This could inform future studies and lead to changes in treatment pathways for patients receiving potentially kidney-toxic medicines, with the aim of reducing their risk of AKI and potential long-term kidney damage.

“My research career started with Kidney Research UK (previously the National Kidney Research Fund), who funded my PhD many years ago. The understanding of scientific mechanisms in kidney disease, which I gained during this time, has enabled my subsequent research programme in AKI. My longstanding interest in AKI developed because I wanted to work on a serious problem which affects a lot of people. Studies like this can contribute to significant advances in detection and management of AKI, a condition which is certainly both common and serious.

“In Nottingham our group’s research was supported by NIHR but also by the Nottinghamshire Kidney Units Appeal, run by a small group of volunteers led by the extraordinarily dedicated and impressive Colin and Gill. I should like to thank this group, which raised vital funds for both Kidney Research UK and for the kidney units at two local hospitals. This funding helped some of our earlier work on these AKI biomarkers and we are grateful to Kidney Research UK and the Thompson Family Charitable Trust for funding an important additional dimension to this work.” Dr Mark Devonald.