In this new ERA podcast Dr George Kosmadakis and Professor Alice Smith talk about physical activity and exercise for people managing Chronic Kidney Disease
Thank you to Dr George Kosmadakis and the pinch of salt team for inviting Professor Alice Smith on to the podcast!
The International Transplantoux Symposium 2024 took place in February in Belgium. It is a conference on the role of physical activity, exercise training, nutrition and psychosocial interventions in patients with chronic organ disease and organ transplantation. This event provided an excellent platform for networking with kidney professionals worldwide and disseminating our work.
Rosey Billany presented results of the ECSERT study which is looking at the effects of home-based exercise in people with a kidney transplant and is funded by Kidney Research UK.
Rosey also had a poster presentation which was looking at the cardiorespiratory fitness in healthy volunteers versus exact age and sex matched kidney transplant recipients showing that the kidney transplant recipients had a reduced exercise capacity. A big congratulations to Rosey for also for winning the best poster award on this!
For further detail on the symposium please visit: https://transplantoux-symposium.org/
Thank you to the International Transplantoux Symposium for organising a fantastic event.
Earlier this month, part of our team attended the American Society of Nephrology (ASN) Kidney Week in Philadelphia and had the chance to showcase our efforts on a global stage. This event provided an excellent platform for networking with kidney professionals worldwide and disseminating our work.
Courtney Lightfoot presented the major findings of our multi-centre randomised control trial SMILE-K, which assessed the effectiveness of our digital self-management application, My Kidneys and Me, in an oral presentation. Additionally, she presented a poster on the acceptability and usability of My Kidneys and Me.
The team went to many of the other presentations and sessions during the event and especially enjoyed the following sessions: Serving the Underserved: Improving Kidney Health in Underserved Populations; Bioengineering, Augmented Intelligence, Digital Health, and Data Science; Nutritional and Lifestyle Interventions to Promote Health in CKD; Implementation: Breaking Barriers to Reach the Bedside; Interventions to Reduce CKD Progression.
Thank you to the ASN for organising another fantastic event.
PhD student Naeema had the opportunity to go to Malmö University as part of an exchange scheme earlier this year. She has written this post about her experience below.
During the second year of my PhD, I was given a fantastic opportunity to visit and present to a group of academics, PhD students and researchers of the Department of Care Sciences at Malmö University in Sweden, as part of an exchange scheme programme with the University of Leicester Department of Population Health Sciences SAPPHIRE group. I would like to thank Malmö University and PhD student Annica Rosvall for organising this whole trip and for being such wonderful hosts. I would also like to thank my supervisor Professor Alice Smith and the lead of SAPPHIRE research group, Professor Carolyn Tarrant, for giving me this wonderful opportunity and experience. I would like to reflect on my experiences through this blog.
I arrived in Malmo on 22nd May 2023, on the first day of the programme, I presented my current PhD work and findings as part of a quality improvement event, highlighting the importance of self-management in kidney disease, my Delphi study on the benefits valued by key stakeholders, and my qualitative interviews of healthcare staff perceptions and experiences. There was time for questions which was a great opportunity to get a deeper insight into our research and methodology. The audience was particularly impressed with MyKidneys&Me, the digital education and self-management resource produced by our Leicester team. To break the ice, there were plenty of discussions with PhD students on our experiences and interests relating to using digital interventions and behaviour change measures and assessments.
I also visited the kidney specialists and healthcare staff at the Skåne University Hospital. I attended their weekly meeting and again presented my PhD work and the work carried out by our team in Leicester. This led to many insightful discussions relating to kidney health and the importance of patient education. It was great to hear about their passion for enhancing patient engagement in kidney disease during the earlier stages. During this session, I was able to talk about my qualitative interviews with kidney specialists in the UK, especially about clinic appointment structure and health services for kidney disease. I was able to speak to one of the nurses in the hospital involved in patient education and management. The current approach used in Skåne University Hospital is group sessions with patients, family members and clinicians in pre-dialysis care to enhance knowledge on CKD and shared decision making. As the patient experiences and improvement were not assessed formally, I suggested how this could be designed into a great research study to evaluate the effectiveness of this approach using qualitative staff, family member and patient experiences and different knowledge and efficacy-based outcome measures.
During my stay, there were plenty of traditional ‘fika’ breaks- a quick chat coffee and tea break, a lovely way of networking where Swedes routinely pause throughout the day. I also noticed the diversity in Malmö on the streets, University Campus and the hospital, just like Leicester. I discussed with one of the researchers how it is crucial to address health inequalities and tailor culturally appropriate services. I was able to discuss and establish research ideas and concepts for kidney disease, other metabolic conditions and public health. We discussed opportunities for fruitful collaboration in the future.
This experience has been great for my professional development, and enhanced my confidence and passion for research on making a difference to improving healthcare services and patient experiences. This experience reinforced my understanding of the impact of my PhD and the work of our team contributing to healthcare.
Part of the team had the opportunity to present our work internationally in June as they attended the European Renal Association 60th Congress in Milan. This was a fantastic opportunity to network with kidney professionals from around the world and share our work, here is a recap of the work presented over the conference:
Roseanne Billany presented two focused orals on her PhD (the ECSERT trial) sharing promising initial results of the effects of a home-based exercise programme on cardiorespiratory fitness in kidney transplant recipients, and the feasibility of the intervention.
Roseanne also presented work on behalf of our PhD student Noemi Vadaszy looking at associations between sarcopenia, cardiovascular health and habitual physical activity in patients on haemodialysis, suggesting exercise should be continued to be promoted to all patients and sarcopenia does not limit the benefits.
Gurneet Sohansoha showcased an electronic poster on the effects of the COVID-19 vaccination rollout on feelings of safety and perceived change in social behaviour, suggesting limited changes to behaviour and high perceived safety. Gurneet also delivered a focused oral on the lessons learnt from virtual recruitment to the multicentre randomised controlled trial (SMILE-K), proposing inviting prospective participants by mailing them after discussing in a remote appointment gained the best consent rate.
Naeema Patel presented two focused orals. The first explored the mental health of people with kidney disease and their significant others before and after the COVID-19 vaccine programme. She also presented initial results from her PhD DELPHI study identifying priority outcomes for education and self-management in non-dialysis chronic kidney disease, suggesting clinical outcomes to be the top priority across groups.
Courtney Lightfoot delivered a focused oral evaluating patient activation status and perceived function impairment in CKD and its association with optimising life participation through enhanced self-management.
The team attended a variety of other presentations throughout the conference. They especially enjoyed the symposium about ‘getting the patient voice heard’ chaired by Daniel Gallego & Juan Carlos Julián, Martin Wilkie’s presentation highlighting the important work by the SONG-CKD initiative, and GREx colleague Diogo Vaz Leal’s presentation on physical activity and physical function in kidney disease.
The research team attended the annual UKKW conference at the ICC Wales in June. It was wonderful to reconnect with researchers from around the country and learn all about the new research in the field. It was also a fantastic opportunity to present our current research, here is a recap of all the work we presented over the week!
Courtney Lightfoot Talk on the relevance and impact of self management in kidney disease @lisa_ancliffe
Naeema patel presenting her talk about mental health and the covid-19 pandemic @tomwilks444
Roseanne billany presenting early results from the escert trial @HMLYOUNGPHYSIO
Courtney Lightfoot gave an invited talk on self-management in kidney disease, and excitingly presented a late-breaking abstract providing the first peek at the remarkable results from the SMILE-K study. Her presentation highlighted that our novel MyKidneys&Me digital health intervention is effective in increasing knowledge, skills and confidence to manage health in people living with kidney disease.
Naeema Patel delivered a presentation discussing the impact of COVID vaccination on the mental health status of individuals with CKD.
Rosey Billany presented the ESCERT kidney transplant exercise trial during the ‘what’s hot, what’s new in kidney transplantation’ session.
Matthew Graham-Brown was a featured speaker at the symposium titled "pioneers in practice: real-life patient experiences in anaemia of CKD management.”
Gurneet Sohansoha received the award for best poster for her poster focusing on the evaluation of recruitment for the virtual clinical trial of the digital health intervention SMILE-K.
Ella Ford, attending her first conference, presented her poster based on data from the DIME-CV study entitled ‘Healthcare system overload and economic recession: the worries of people with chronic kidney disease and their significant others during the COVID-19 pandemic: a sign of things to come in the UK?’
Naeema Patel showcased her poster on her PhD DELPHI study, identifying what people living with kidney disease and kidney healthcare professionals consider to be priority outcomes for the self-management of kidney disease.
We’d like to say thank you to the organising team at the UK Kidney Association for a fantastic event.
2022 was a great year for our team! Some highlights include:
courtney lightfoot and her poster presenting the SMILE-K pilot findings of our online self-management program at the asn kidney week (Image credit: @courtneyjlight)
Naeema patel presenting her talk about patient activation and coping during the COVID-19 pandemic at uk kidney week (Image credit: @tomwilks444)
We published 32 journal articles, a selection of these can be viewed on PubMed
We presented 21 research abstracts at 6 national and international conferences including the American Society of Nephrology Kidney Week Conference in Orlando Florida, the European Renal Association Congress in Paris and the UK Kidney Association UK Kidney Week.
We gave 26 invited lectures and seminars at local, national and international events including:
Tom Wilkinson was an invited speaker at the American Society of Nephrology Kidney Week Conference 2022 in Orlando, FL. His talk was entitled: ‘Exercise to Improve Outcomes in CKD: Evidence for Benefit?’
Rosey Billany who was invited to deliver a workshop and act as session chair and speaker at the Transplantoux Symposium 2022 in Leiden, Belguim. The workshop was on ‘Physical Activity Type and Intensity: what should we aim for?
Matt Graham-Brown was invited to speak at the Kidney Research RUK Research Showcase at the Royal College of Physicians in London. His presentation was entitled: ‘Cardiovascular Disease and Exercise: A model to understand disease mechanisms and improve patient care.’
Noemi Vadaszy ran a Global Renal Exercise (GREX) Young Webinar for World Kidney Day entitled: ‘The validity of the SF-12 to measure physical function in people with non-dialysis CKD
Visiting the eiffel tower in paris at the era conference (IMAGE CREDIT: Alice smith)
KIDNEY RESEARCH LIFESTYLE TEAM AND INTERNATIONAL GREX COLLEAGUES AT THE ERA CONFERENCE IN PARIS (IMAGE CREDIT: @EURORECKD)
We published the first NICE-endorsed Clinical Practice Guidelines for Exercise and Lifestyle in Kidney Disease : 9 of the consortium of 17 guideline authors are based in Leicester and associated with our team
With our colleagues from Respiratory Medicine and Cardiovascular Sciences, we established the University of Leicester Muscle Health Development Centre
We contributed to the University of Leicester’s fantastic Research Excellence Framework rankings in Sport and Exercise (UoA24) and Clinical Medicine (UoA1)
We are proud to be part of the Leicester NIHR Biomedical Research Centre, which was awarded £26million in new funding in 2022
Our SMILE-K multicentre randomised controlled trial completed recruitment at 26 hospital sites across England at the end of 2022. The preliminary results will be available in June 2023. Read about the SMILE-K study on our website here. The SMILE-K protocol is published here
We look forward to what more we can achieve in 2023! View our current studies here, and follow us on twitter to keep up to date with our work.
We have recently launched a new survey as part of our DIME-KD study. DIME-KD Part E is open to people living with kidney disease and their “significant others” (i.e. those they live with or are close to). The new survey asks participants about their experiences and the impacts of sleep problems, and also how they use and benefit from natural environments (referred to as “green and blue space” i.e. gardens, parks, woodland, countryside, rivers, lakes, seaside etc).
DIME-KD Part E consists of an online survey, with an additional option of a one-to-one interview with a researcher to explore the topics more in-depth. The study is recruiting in Leicester as well as eight other hospital sites across England. These sites range from inner-city to rural locations, and this will allow for a diverse range of environmental settings which may affect both sleep problems and access to and use of green and blue space.
The study was designed in response to findings from our previous research and from discussions with people with kidney disease. Many patients have told us that they suffer from sleep problems, and we want to understand the nature of these problems, how they affect day-to-day life, health and well-being, and what might help them to sleep better. During the pandemic, the importance of time spent in the outdoors and especially in the natural environment became very clear for everyone, but especially those with clinical conditions such as kidney disease who may have had to shield and isolate for longer than healthy people.
The DIME-KD Part E study will provide our researchers with a lot of information about these two topics. We aim to use the results to develop ways to help people with kidney disease, their families and friends, and their healthcare staff improve kidney patient health and well-being. We will also use the results to influence health service policy and delivery to focus on what matters most to those whose lives are affected by kidney disease.
You can read more about what else our DIME-KD study entails and the work we have published so far here.
If you are over eighteen and have chronic kidney disease, a kidney transplant or you are receiving dialysis, and you are under the care of a kidney doctor at one of our partner sites, you may receive a letter inviting you and someone close to you to take part. Please contact the study team for more information: dimekd@uhl-tr.nhs.uk.
Despite the enormous disruption to our research activities and the extended suspension of the majority of NHS research, a total of 1,429 kidney patients, their “significant others” and healthcare staff from across the whole of England participated in our Kidney Lifestyle research studies in 2020
We published 18 peer-reviewed journal articles in 2020 (details here)
We were invited by the very prestigious journal Nature Reviews in Nephrology (IF19.68) to write an editorial article on ‘Living Well with Kidney Disease’ to coincide with World Kidney Day 2021
·We managed to continue our participation in a range of external outreach activities to disseminate our research findings and raise the profile of lifestyle for kidney patients. The usual conferences, seminars and face-to-face events were all cancelled from March onwards but we adapted quickly and the team engaged actively in at least 26 national and international events, most of them virtual. Members of the team gave three expert invited lectures and 20 research presentations, and actively contributed in many capacities such as acting as session chairs and webinar facilitators and participating in online chats and discussions associated with virtual events. In addition, we made frequent use of our website and social media channels to disseminate our work and engage in conversations with the kidney community.
Six members of our team, along with three others from Leicester and eight from other UK institutions, produced the National Renal Association Clinical Practice Guidelines for Exercise and Lifestyle in Kidney Disease
We supported a range of research degrees, with four PhDs and an intercalated medical MSc degree awarded. This year we are hosting four current PhD students, one MPhil student and one intercalated medical student. We are also likely to host other Masters level projects over the summer.
Four months since we helped launch Kidney Beam, a new online service helping kidney patients take care of their physical and mental health, we are delighted to announce that Kidney Research UK have extended our funding for another year. This means the platform is free for the kidney community to enjoy for another 12 months. We’ll have more news on Beam developments and some exciting research plans soon.
https://beamfeelgood.com/kidney-disease
https://kidneyresearchuk.org/2020/11/26/free-kidney-beam-service-for-patients-to-continue-for-another-year/?bblinkid=245649050&bbemailid=26088077&bbejrid=1744231794
We have recently added a new part to our ongoing DIME-KD study which will explore the impact of the Covid pandemic on lifestyle and access to healthcare of people living with kidney disease. DIME-KD Part CV consists of an online survey for kidney patients, their significant others and the healthcare staff involved in their care. There is also an optional one-to-one telephone interview to explore the issues in more depth. DIME-KD Part CV is recruiting in Leicester and 10 other hospital sites around England and aims to help us understand the healthcare and support needs of a diverse range of people with kidney disease, also taking into account the perspectives of those who are close to them and provide their healthcare. We will use this information to design and deliver innovative approaches to lifestyle and self-management which are tailored to the needs of the users and relevant stakeholders in the post-Covid era.
See the latest press release from the NIHR Leicester Biomedical Research Center about the study here.
If you have CKD or a kidney transplant under the care of a kidney doctor at one of our partner sites, you may receive a letter inviting you and someone close to you to take part. Please contact the study team for more information : dimekd@uhl-tr.nhs.uk
If you haven’t yet visited Kidney Beam, there is still time to do so as Kidney Research UK is funding free access to the activities and resources until the end of November 2020 for patients and professionals with an interest in kidney disease.
How it works
Kidney Beam gives patients the chance to take control of their mental and physical wellbeing at their own pace, with guidance (if needed), from people who understand the complexities of kidney health.
The online platform is hosted by specialist kidney professionals – from renal physiotherapists to renal counsellors – from a number of different NHS trusts and backgrounds, as well as people living with kidney disease. And it has broad appeal – it’s aimed at anyone over 16, with any ability, any kidney condition, and at any stage of kidney disease.
All classes have a fitness rating so patients can choose the right one for them. At the beginning and end of the classes people can chat to each other and the instructors, building friendships which might help them stay motivated.
With free, open access, patients anywhere can sign up to the service without a referral being needed from their doctor or consultant. However, we know that clinician recommendations were the most effective way of recruiting patients to the platform when it was developed for people with cystic fibrosis so please do share a link to the platform with your patients and advise them it is free to sign-up until the 30th November 2020 if they choose ‘kidney disease’. Here is the link https://beamfeelgood.com/home
We are excited that the platform will give patients an easy, fun way to improve their health by bringing the experts, friends and health studio to them, wherever they are.
We hope you will be able to support this very exciting project. Here is a link if you would like to take a tour of the platform https://www.youtube.com/watch?v=ZtV2xefQ0Nc&feature=youtu.be
Here is a sample of classes you might be interested in:
Get started, to ease you in: https://beamfeelgood.com/liveClass/kidney-disease/316
physio-led pilates: getting stronger: https://beamfeelgood.com/liveClass/kidney-disease/328
wake up, work out: HIIT: https://beamfeelgood.com/liveClass/kidney-disease/326
keep moving: to help you do more: https://beamfeelgood.com/liveClass/kidney-disease/317
advanced circuit training: https://beamfeelgood.com/liveClass/kidney-disease/324
get your muscles moving: https://beamfeelgood.com/liveClass/kidney-disease/321
physio-led pilates: lets get started: https://beamfeelgood.com/liveClass/kidney-disease/327
yoga for people with kidney conditions: https://beamfeelgood.com/liveClass/kidney-disease/325
wake up work out: circuit training: https://beamfeelgood.com/liveClass/kidney-disease/323
And of course an introduction to HIIT by our researcher Rosey Billany https://beamfeelgood.com/programmes/detail/kidney-disease/12
The Global Renal Exercise Network (GREX) was established between international experts to aid kidney care research and gain more understanding on kidney health.
The greater goal of GREX is to foster collaborative research & innovation across multiple disciplines to develop effective and feasible strategies to increase physical activity and exercise participation in order to optimise health outcomes in people with a kidney condition.
Facilitate the completion of rigorous, international, multidisciplinary, exercise and physical activity research
Support the development and implementation of multidisciplinary, collaborative models and strategies to promote behavioural and lifestyle change, both locally and globally
Increase awareness of the therapeutic benefits of physical activity in people with all stages of kidney disease, among patients, their caregivers, and healthcare providers
Researchers on our team contribute to GREX in a number of ways:
Dr Thomas Wilkinson is a GREX organising committee member and is currently conducting a review on physical function across the different stages of kidney disease
Dr Courtney Lightfoot is involved in creating exercise guidelines for patients with Peritoneal Dialysis and is also contributing towards the previously mentioned review in physical function. Dr Lightfoot was also involved in organising an exercise policy barriers and enables workshop.
Professor Alice Smith has also contributed towards the exercise policy consensus statement issued by the network
Noemi Vadaszy sits on the student committee, which organises regular student webinars for all GREX members. Noemi also presented at one of the webinars.
Our researchers also regularly participate in the events hosted by GREX such as webinars and journal clubs. More information about these events can be found in our ‘Upcoming Events’ section.
One of our researchers was recently awarded a University of Leicester Merit Award. Dr Thomas Wilkinson was awarded the Merit Award by the Department of Health Sciences for exceptional and significant contribution over and above the normal expectations of the role. Last year, Tom published 10 articles and gave talks in Italy, Portugal, and in the UK. He was also appointed UK representative and Scientific Director of the Global Renal Exercise Group Organising Committee Member.
A new study published by our team in the journal Kidney Research in Clinical Practice called ‘Response of the Oxygen Uptake Efficiency Slope to Exercise Training in Patients With Chronic Kidney Disease’ showed that 12-weeks of exercise may have a limited effect on the fitness in people with a kidney condition.
People with a kidney condition have poor fitness levels which can be improved through regular exercise. However, in other studies we have done we have noticed that not all people improve their fitness by doing exercise. We think this could be because of problems in the muscles. It may also be due to the way we measure fitness. The best way to test fitness is through something called a ‘maximal cardiopulmonary exercise test’. This involves measuring the maximum amount of oxygen our bodies can use during exercise. This is often done by cycling on a static bike wearing a special mask that can measure oxygen and carbon dioxide in our breaths. This test can get very difficult as the resistance on the bike increases and many people stop the test early due to different reasons such as tiredness, pain, or lack of motivation. If the test is stopped early, then we do not get an accurate picture of what someone’s maximum fitness is.
To get around this we looked at something called the oxygen uptake efficiency slope (OUES). Rather than looking at the oxygen at the end of the fitness test, this slope is measured by assessing how a person’s need for oxygen changes during the test. This is a more pragmatic and safer alternative to maximal testing and does not rely on maximum effort by someone doing the test.
We looked at 32 people with CKD who underwent a 12-week exercise program consisting of mixed aerobic and strength training three times a week. The fitness test was conducted before and after the exercise. We saw no changes were observed in any fitness variable as a result of exercise. This includes analysis of the oxygen uptake efficiency slope.
Our results show that 12 weeks of exercise training had no beneficial effects on the fitness levels of people completing the study. This could mean that people do not respond to exercise as well as those without kidney disease. It could also mean that people need to do exercise for longer (than 12-weeks) to see an effect. This shows that regular exercise is important for people with a kidney condition.
A link can be found here to the scientific article: https://pubmed.ncbi.nlm.nih.gov/32550710/
The researchers involved in the study were Dr Thomas J Wilkinson, Dr Emma L Watson, Noemi Vadaszy, Dr Luke A Baker, Prof João L Viana, Prof Alice C Smith.
Have you heard of Beam for Kidney Disease? It’s an online platform aiming at improving health and well-being for people with kidney disease, at any stage. It offers on-demand and live classes, plus friendly groups, led by specialist physiotherapists and trainers and is funded by Kidney Research UK.
Our researchers, Rosey Billany and Noemi Vadaszy, participate as instructors in the initiative and Tom Wilkinson answers questions about the importance of strength training. You can have a taste of their on-demand classes here.
We are also happy that NIHR Leicester Biomedical Research Center talked with our researchers and promotes the initiative (read more here).
Dr Thomas Wilkinson presented the benefits of exercise on reducing cardiovascular risk factors in people with a kidney conditions. If you are interested in watching his talk, click on the link below
The current situation has changed all of our lives. Unfortunately, charities are no exception. To help UK charities, the organisers of the biggest mass participation sports events across the country have come together to create a new campaign to raise vital funds.
The campaign, The 2.6 Challenge, was launched on Sunday 26 April 2020 – on what would have been the 40th London Marathon, which raised £66.4 million for charities in 2019 (£135,000 was raised by #TEAMKIDNEY for Kidney Research UK). The challenge lasted for a week but we will keep our fundraising page open for another month.
As a research team, we are supporting Kidney Research UK with our participation in the 2.6 Challenge. In the video below, you will see all the different activities our team members got up to in the past week as part of the challenge. Please also read our fundraising page for Kidney Research UK.
Keep research going!
There are some simple things you can do to help you take care of your mental health and wellbeing during this time.
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