Chronic kidney patients at risk from infections
The mortality rate of patients with a chronic kidney disorder is higher than that of healthy people. Dinanda van Appeldoorn-de Jager discovered that infections are an important risk factor. Gaining a better understanding of the risk factors is an essential step to improving the survival rate. Her findings have been published in the prestigious Journal of the American Medical Association. PhD defence 17 October 2012.
‘11% of people suffer from a chronic kidney disease, which is quite high number,' PhD candidate Van Appeldoorn-de Jager explains, indicating the importance of kidney research. She studied the causes of death in a group of kidney dialysis patients. ‘The general opinion is that dialysis patients have a higher mortality rate because they are more likely than healthy people to die of cardiovascular diseases. That is true, but we have now demonstrated that they are also more likely to die of other causes, particularly infections. This is a very important finding because a lot of research focuses only on deaths from cardiovascular disease, while there are other equally significant causes of death. This finding may have a major influence on future scientific research.'
PhD supervisor Friedo Dekker gives an added dimension to the research findings: 'When she was a student, Dinanda was already researching the significance of death from cardiovascular disease among kidney patients. The analyses that she made then have now led to her publication in the Journal of the American Medical Association (JAMA). This is a good illustration of how being actively involved in research when you are a student can have some excellent effects later.' Van Appeldoorn-de Jager is well prepared for her PhD defence: 'I am almost certain I will be asked questions about the article that forms part of my dissertation.'
Even while studying for her Biomedical Sciences programme Van Appeldoorn-de Jager was already very driven in seeking the risk factors for illnesses. During her internship in the Epidemiology department of the LUMC she concentrated on kidney patients, and her research there formed the basis of her PhD research. She focused on the progression of chronic kidney disease in patients who are being prepared for dialysis treatment.
In her research, Van Apeldoorn-de Jager also discovered that a family history of diabetes, cardiovascular disease and kidney disease influences the progress of the disease. It is not possible to influence family history, but it is important to understand that it can speed up the progress of the disease. Two elements that have a direct influence appear to be the levels of calcium and phosphate in the body. Further research is needed to confirm this.
It was already known that people who are given a lengthy preparation for the start of dialysis have a better survival rate than people who are referred for dialysis at too late a stage. Van Appeldoorn-de Jager investigated whether age or diabetes is a factor. She concluded that it is well worthwhile ensuring people are well prepared, whether they are young or old and whether they do or do not suffer from diabetes. She also analysed the status of the kidney function at the start of dialysis. The functioniing of the kidney may continue to show some deterioration, but after two to four months the rate of deterioration slows down. Van Appeldoorn-de Jager is currently continuing with her work constructing databases of information of dialysis and pre-dialysis patients. These databases will provide the opportunity for further analyses to be made.
D.J. van Appeldoorn-de Jager
'Progression of CKD from pre-dialysis to dialysis: natural course, risk factors, and outcomes'
Date: Wednesday 17 October 2012
Location: Academy Building
PhD supervisor: Prof. F.W. Dekker
(12 oktober 2012)
Cardiovascular and Noncardiovascular Mortality Among Patients Starting Dialysis, JAMA, Journal of the American Medical Association, October 28, 2009, Vol 302, No. 16
- Health across the human cycle is one of the six themes of research at Leiden University.