Could filtering blood remove a toxic substance and protect the kidneys during surgery?
Mr James Bennett, a clinical perfusion scientist at the Liverpool Heart and Chest Hospital has received a Kidney Research UK allied health professional fellowship award of £140,000 to fund his PhD at the University of Liverpool. James will look at developing a special type of filter to remove a substance toxic to the kidneys released by red blood cells during some types of surgery.
The role of a clinical perfusion scientist
Clinical perfusion scientists are part of the surgical team. They mainly work in heart and aortic surgery, using life support devices to keep blood flowing to the patients' organs and body tissues. These devices temporarily perform the roles of organs such as the heart and lungs during surgical procedures.
The problem
Acute kidney injury (AKI) is a sudden loss of, or reduction in kidney function, that can be permanent or temporary. It happens in more than 60% of patients following surgery to repair the thoracoabdominal aorta (a large artery found in the chest behind the heart and in the abdomen). During this surgery, blood flow to the part of the artery needing repair is stopped. To ensure that blood still reaches the rest of the body it may be redirected to a machine then returned to the patient. However, this can damage red blood cells, through a process called haemolysis.
About haemolysis
Haemolysis describes the destruction of red blood cells causing them to release their contents into the blood, including a protein called haemoglobin which usually helps the cells carry oxygen. When released into the bloodstream, haemoglobin can be broken down into compounds that are harmful to the kidneys.
James’ work follows from the HaemoAKI study, supported by a Kidney Research UK - Stoneygate Start Up grant, which showed patients who developed AKI following surgery on the thoracoabdominal aorta have higher levels of free haemoglobin in their blood.
The solution
James will look at using a filter made from a type of molecule which binds to haemoglobin to remove it from the blood. Blood from surgical patients containing damaged red blood cells and their toxic product will be passed through this filter then added to kidney cells. James will look at the proteins in the kidney cells and their survival. This will be compared to when the blood is added unfiltered, which will allow James to look at how kidney cells respond to damaged blood, and whether the filter reduces injury to these cells.
By also comparing proteins in damaged kidney cells to those in urine sample cells from surgical patients this could help inform development of urine tests for AKI following surgery.
What could this mean for kidney patients?
By better understanding how the kidneys are impacted by damaged red blood cells and developing a new type of medical filter which could remove a toxic product released by these cells, James’ work could inform interventions to reduce the risk of AKI for patients undergoing this type of surgery in the future.
“I hope that my fellowship shows the importance of researching this area of surgery further so that future studies can find ways of preventing patients from developing AKI after aortic surgery. This could mean that patients would be able to go home quicker after surgery and will reduce the likelihood of spending weeks or months on dialysis.” Mr James Bennett.
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