Geoff Kirkland - Academia.edu (original) (raw)

Papers by Geoff Kirkland

Research paper thumbnail of 924919_online_appendix – Supplemental material for Acute kidney injury, stroke and death after cardiopulmonary bypass surgery: the role of perfusion flow and pressure

Supplemental material, 924919_online_appendix for Acute kidney injury, stroke and death after car... more Supplemental material, 924919_online_appendix for Acute kidney injury, stroke and death after cardiopulmonary bypass surgery: the role of perfusion flow and pressure by Laura Turner, Ashutosh Hardikar, Matthew D Jose, Keshav Bhattarai, Carmel Fenton, Rajiv Sharma, Geoff Kirkland, Lisa Jeffs, Monique Breslin, Bruna Silva Ragaini and Richard F Newland in Perfusion

Research paper thumbnail of Infectious complications in the Southern Tasmanian kidney transplant population

Nephrology, 2019

This is the author manuscript accepted for publication and has undergone full peer review but has... more This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Research paper thumbnail of Abo-Incompatible Renal Transplantation Without Splenectomy or Rituximab – Excellent Renal Function and Graft Histology

Transplantation, 2008

Masterson et al had shown that in their series of 20 patients with low blood group antibody titer... more Masterson et al had shown that in their series of 20 patients with low blood group antibody titers (ABGAb) who underwent ABO-incompatible (ABOi) live donor renal transplantation with standard immunosuppression and without antibody removal had 100% patient and graft survival at the end of 36 months (1). We report two patients from our centers who received ABOi live donor renal transplantation with low-level ABGAb with standard immunosuppression and no antibody removal, but with opposite results.

Research paper thumbnail of Chronic kidney disease in Tasmania

Nephrology, 2009

Chronic kidney disease (CKD) is a progressive disease which is becoming a major public health iss... more Chronic kidney disease (CKD) is a progressive disease which is becoming a major public health issue due to its high rate of premature death, poor quality of life and expensive end-stage treatment (dialysis or transplantation). The burden of this chronic condition in a community setting was examined. Data were obtained from 369,098 Tasmanian adults (aged >or=18 years) and included 1,640,687 measurements of creatinine taken between 1995 and 2007. In 2007 alone, testing comprised 25.5% of the state's adult population. A modelled estimate of CKD prevalence was developed. For those at risk of CKD (aged >50 years), 50.6%, 70.2% and 82% had a measured creatinine (and reported estimated glomerular filtration rate (eGFR)) during the last 1, 2 and 3 years respectively. However, only 9.4% of people with eGFR of less than 60 mL/min per 1.73 m(2) had albuminuria formally measured. Estimated prevalence of stage III or greater CKD (eGFR <60 mL/min per 1.73 m(2)) was at least 11.4% of women and 8.6% of men during 2007. Detection of low eGFR increased significantly over the last 13 years. There was a large geographic variation throughout Tasmania and high relative mortality with lower eGFR. There is a broad gap between the number of people with eGFR of less than 15 mL/min per 1.73 m(2) (stage V CKD) and those receiving dialysis treatment. The number of people identified with low eGFR has increased significantly since 1995 with a large geographic variation. Despite this, testing for kidney disease (by measuring serum creatinine and albuminuria) in people at risk is still suboptimal.

Research paper thumbnail of Snake venom allergy

Medical Journal of Australia, 1990

Research paper thumbnail of Acute granulomatous interstitial nephritis in a patient with metastatic melanoma on targeted therapy with dabrafenib and trametinib — A case report

Cancer Reports

BACKGROUND Combination molecular targeted therapy with dabrafenib plus trametinib has been shown ... more BACKGROUND Combination molecular targeted therapy with dabrafenib plus trametinib has been shown to improve progression-free survival and overall survival in patients with BRAF V600 mutated unresectable or metastatic melanoma. In general, these agents are well tolerated. Kidney related adverse events are uncommon with only three case reports of acute interstitial nephritis and one case of a serious acute kidney injury. We report another case of interstitial nephritis related to these drugs. CASE A 37-year-old man diagnosed with metastatic melanoma (BRAF V600E mutation) who developed acute interstitial nephritis 5 years into his treatment with combination dabrafenib plus trametinib therapy. He presented with an asymptomatic acute kidney injury on routine surveillance pathology with a creatinine of 174 μmol/L (from baseline 80 μmol/L) and a corresponding estimated glomerular filtration rate (eGFR) of 42 ml/min/1.73 m2 (from a baseline >90 ml/min/1.73 m2 ) and microalbuminuria (albumin creatinine ratio [ACR] 8.5 mg/mmol). Renal biopsy revealed a granulomatous interstitial nephritis likely drug related. He was treated with prednisolone 1 mg/kg and ceased his targeted therapy with improvement in his renal function. CONCLUSION Although rare, recognition of acute interstitial nephritis, a possible serious adverse outcome due to dabrafenib and trametinib is important and needs to be incorporated into current Australian cancer therapy guidelines.

Research paper thumbnail of Acute kidney injury, stroke and death after cardiopulmonary bypass surgery: the role of perfusion flow and pressure

Perfusion

Introduction: Acute kidney injury after cardiopulmonary bypass surgery is associated with morbidi... more Introduction: Acute kidney injury after cardiopulmonary bypass surgery is associated with morbidity and mortality. This study aims to evaluate the role of low perfusion flow and pressure in the development of cardiopulmonary bypass–associated acute kidney injury, stroke and death, using multicentre registry data. Methods: We identified patients from the Australian and New Zealand Collaborative Perfusion Registry who underwent coronary artery bypass grafting and/or valvular surgery between 2008 and 2018. Primary predictor variables were the length of time the perfusion flow was <1.6 L/min/m2 and the length of time perfusion pressure was < 50mmHg. The primary outcome was new postoperative acute kidney injury defined by the risk-injury-failure-loss-end stage criteria. Secondary outcomes were stroke and in-hospital death. The influence of perfusion flow and pressure during cardiopulmonary bypass on the primary and secondary outcomes was estimated using separate multivariate models...

Research paper thumbnail of Genetic Kidney Disease in Southern Tasmania

Kidney International Reports

SUPPLEMENTARY MATERIAL Supplementary File (Word) Supplementary References. Supplementary Methods.... more SUPPLEMENTARY MATERIAL Supplementary File (Word) Supplementary References. Supplementary Methods. Table S1. Patient characteristics, previous peritonitis, laboratories, and outcome. Table S2. Accuracy of serum galactomannan index for differentiating fungal peritonitis at different cutoff points.

Research paper thumbnail of Assessment of current practice and barriers to antimicrobial prophylaxis in peritoneal dialysis patients

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Jan 22, 2015

Existing Australasian and international guidelines outline antibiotic and antifungal measures to ... more Existing Australasian and international guidelines outline antibiotic and antifungal measures to prevent the development of treatment-related infection in peritoneal dialysis (PD) patients. Practice patterns and rates of PD-related infection vary widely across renal units in Australia and New Zealand and are known to vary significantly from guideline recommendations, resulting in PD technique survival rates that are lower than those achieved in many other countries. The aim of this study was to determine if there is an association between current practice and PD-related infection outcomes and to identify the barriers and enablers to good clinical practice. This is a multicentre network study involving eight PD units in Australia and New Zealand, with a focus on adherence to guideline recommendations on antimicrobial prophylaxis in PD patients. Current practice was established by asking the PD unit heads to respond to a short survey about practice/protocols/policies and a 'proces...

Research paper thumbnail of Heparin-binding EGF-like growth factor mRNA is upregulated in the peri-infarct region of the remnant kidney model: in vitro evidence suggests a regulatory role in myofibroblast transformation

Journal of the American Society of Nephrology : JASN, 1998

Heparin-binding epidermal growth factor-like growth factor (HB-EGF) is a potent fibroblast and ep... more Heparin-binding epidermal growth factor-like growth factor (HB-EGF) is a potent fibroblast and epithelial cell mitogen that may be important in wound healing. The aim of this study was to determine its distribution and possible function in segmental renal infarction. At day 1 postinfarction, in situ hybridization showed that HB-EGF mRNA was markedly increased by tubular epithelial cells bordering the infarcted zone. At day 3, typical myofibroblasts expressing alpha-smooth muscle actin (alpha-SMA) were present in large numbers at the peri-ischemic border and, over succeeding days, were also seen within the infarcted area. Some of these cells expressed HB-EGF mRNA by in situ hybridization suggesting possible autocrine stimulation. Endothelial cells appeared to be more resistant to ischemia than tubules because some capillaries at the periphery of the infarct, surrounded by infarcted tubules, also expressed HB-EGF mRNA. The staining intensity of HB-EGF mRNA in individual tubules and en...

Research paper thumbnail of Classical polyarteritis nodosa and microscopic polyarteritis with medium vessel involvement--a comparison of the clinical and laboratory features

Clinical nephrology, 1997

Microscopic polyarteritis may involve medium-sized and small blood vessels as well as arterioles,... more Microscopic polyarteritis may involve medium-sized and small blood vessels as well as arterioles, venules and capillaries. We have compared the clinical and laboratory features in patients with microscopic polyarteritis and medium vessel involvement, with the features found in patients with polyarteritis nodosa affecting medium vessels alone. In a 9-year period, 21 patients presented to our hospital with a form of polyarteritis. Seven had microscopic polyarteritis demonstrated histologically (6/7, 86%) and associated with dysmorphic urinary red cells (7/7, 100%), as well as medium vessel vasculitis demonstrated histologically (7/7) or by angiography (1/7, 14%). Five patients had polyarteritis nodosa with medium vessel vasculitis demonstrated histologically (3/5, 60%) or by angiography (2/5, 40%); and no evidence of a glomerular vasculitis on biopsy (2/7, 29%) or in the urinary sediment (0/7, 0%). The remaining 9 patients had microscopic polyarteritis but medium vessel involvement wa...

Research paper thumbnail of ABO-INCOMPATIBLE RENAL TRANSPLANTATION WITHOUT SPLENECTOMY OR RITUXIMAB – EXCELLENT RENAL FUNCTION AND GRAFT HISTOLOGY

Research paper thumbnail of Factors Associated with Chronic Kidney Disease Progression in Australian Nephrology Practices

Nephron Clinical Practice, 2012

rapid decline in eGFR (p = 0.007, 0.033, and 0.003, respectively). On multivariate analysis: gend... more rapid decline in eGFR (p = 0.007, 0.033, and 0.003, respectively). On multivariate analysis: gender, age, prescription of ESA and phosphate binders, and baseline eGFR were significantly associated with CKD progression (p = 0.003, 0.004, ! 0.001, 0.029, and ! 0.001, respectively). Conclusions: This study identifies potential factors associated with CKD progression in a population referred to nephrologists, but current data quality may result in bias. Implementation of changes in the format of data collection is required so that busy clinicians record essential information to enable this to become a more accurate and reliable research tool.

Research paper thumbnail of Darbepoetin alfa administered monthly maintains haemoglobin concentrations in patients with chronic kidney disease not receiving dialysis: A multicentre, open-label, Australian study

Nephrology, 2007

Darbepoetin alfa, an erythropoiesis-stimulating protein, has a longer serum half-life than recomb... more Darbepoetin alfa, an erythropoiesis-stimulating protein, has a longer serum half-life than recombinant human erythropoietin, allowing less-frequent administration. This study aimed to demonstrate that once-monthly (QM) darbepoetin alfa administration would maintain haemoglobin (Hb) concentrations in subjects with chronic kidney disease (CKD) not receiving dialysis who had previously been administered darbepoetin alfa every 2 weeks (Q2W). Methods: This was a multicentre study in which subjects with CKD receiving stable Q2W darbepoetin alfa doses and with stable Hb (100-130 g/L) were started on QM darbepoetin alfa dosing. The initial QM darbepoetin alfa dose was equivalent to the cumulative darbepoetin alfa dose administered during the month preceding enrolment. Darbepoetin alfa doses were titrated to maintain Hb concentrations between 100 and 130 g/L. The primary endpoint was the proportion of subjects maintaining mean Hb 3 100 g/L during the evaluation period (weeks 21-33). Results: Sixty-six subjects were enrolled in the study and all received at least one dose of darbepoetin alfa; 55 (83%) had mean Hb 3 100 g/L during evaluation. Mean (SD) Hb concentrations at baseline and during the evaluation period were 119 (8.7) g/L and 114 (9.8) g/L, respectively. The median QM darbepoetin alfa dose at baseline and during the evaluation period was 80 mg. Darbepoetin alfa was considered to be well-tolerated. Conclusion: Patients with CKD not receiving dialysis who are receiving darbepoetin alfa Q2W can be safely and effectively extended to darbepoetin alfa QM. Dosing QM may simplify anaemia management for patients and health-care providers.

Research paper thumbnail of Upregulation of heparin-binding epidermal growth factor-like growth factor and osteopontin in experimental hydronephrosis

Research paper thumbnail of Exercise intolerance in Kearns-Sayre syndrome

Journal of Clinical Neuroscience, 1996

Exercise intolerance is a common finding in mitochondrial diseases, including Kearns-Sayre syndro... more Exercise intolerance is a common finding in mitochondrial diseases, including Kearns-Sayre syndrome (KSS), characterised by progressive external ophthalmoplegia, cardiac conduction defects and atypical pigmentary degeneration of the retina. Exercise studies were performed in a 32 year old woman with KSS who had received an atrio-ventricular sequential pacemaker because of continuing breathlessness, having presented with complete heart block requiring a fixed rate demand pacemaker 6 years earlier. Minute ventilation, oxygen consumption, and carbon dioxide production were measured at different workloads on 3 consecutive days by collecting expired air. Compared to controls, after exercise at a subanaerobic workload, heart rate and ventilation were exaggerated relative to both oxygen consumption and carbon dioxide production. The findings are consistent with the hypothesis that, in mitochondrial disorders, impaired oxidative phosphorylation leads to uncoupling of cardiac ouput and ventilation relative to muscle metabolic rate.

Research paper thumbnail of Heparin Binding Epidermal Growth Factor-like Growth Factor Is a Transforming Growth Factor β-Regulated Gene in Intestinal Epithelial Cells

Biochemical and Biophysical Research Communications, 1999

Research paper thumbnail of Polyarteritis nodosa and Antiglomerular Basement Membrane Disease without Antineutrophil Cytoplasm Antibodies

American Journal of Nephrology, 1996

Antiglomerular basement membrane (GBM) antibodies have been described previously in patients with... more Antiglomerular basement membrane (GBM) antibodies have been described previously in patients with microscopic polyarteritis but not in patients with polyarteritis nodosa alone. Where anti-GBM antibodies occur in microscopic polyarteritis, antineutrophil cytoplasm antibodies (ANCA) are usually present. We describe here a patient with polyarteritis nodosa and anti-GBM antibodies in whom ANCA could not be demonstrated. A 72-year-old woman presented with abdominal pain, diarrhoea and acute renal failure. A renal biopsy showed crescentic glomerulonephritis and linear immunofluorescence of the GBM consistent with anti-GBM disease. In addition, there was evidence of large-and medium-sized vessel vasculitis on abdominal angiography, performed because of persisting abdominal pain. There was no small vessel vasculitis on histological examination of the renal biopsy and ANCA could not be demonstrated by indirect immunofluorescence or ELISA.

Research paper thumbnail of Cutaneous necrosis from calcific uremic arteriolopathy

American Journal of Kidney Diseases, 1998

Research paper thumbnail of Chronic kidney disease in Tasmania

Nephrology, 2009

Chronic kidney disease (CKD) is a progressive disease which is becoming a major public health iss... more Chronic kidney disease (CKD) is a progressive disease which is becoming a major public health issue due to its high rate of premature death, poor quality of life and expensive end-stage treatment (dialysis or transplantation). The burden of this chronic condition in a community setting was examined. Data were obtained from 369,098 Tasmanian adults (aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=18 years) and included 1,640,687 measurements of creatinine taken between 1995 and 2007. In 2007 alone, testing comprised 25.5% of the state&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s adult population. A modelled estimate of CKD prevalence was developed. For those at risk of CKD (aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50 years), 50.6%, 70.2% and 82% had a measured creatinine (and reported estimated glomerular filtration rate (eGFR)) during the last 1, 2 and 3 years respectively. However, only 9.4% of people with eGFR of less than 60 mL/min per 1.73 m(2) had albuminuria formally measured. Estimated prevalence of stage III or greater CKD (eGFR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;60 mL/min per 1.73 m(2)) was at least 11.4% of women and 8.6% of men during 2007. Detection of low eGFR increased significantly over the last 13 years. There was a large geographic variation throughout Tasmania and high relative mortality with lower eGFR. There is a broad gap between the number of people with eGFR of less than 15 mL/min per 1.73 m(2) (stage V CKD) and those receiving dialysis treatment. The number of people identified with low eGFR has increased significantly since 1995 with a large geographic variation. Despite this, testing for kidney disease (by measuring serum creatinine and albuminuria) in people at risk is still suboptimal.

Research paper thumbnail of 924919_online_appendix – Supplemental material for Acute kidney injury, stroke and death after cardiopulmonary bypass surgery: the role of perfusion flow and pressure

Supplemental material, 924919_online_appendix for Acute kidney injury, stroke and death after car... more Supplemental material, 924919_online_appendix for Acute kidney injury, stroke and death after cardiopulmonary bypass surgery: the role of perfusion flow and pressure by Laura Turner, Ashutosh Hardikar, Matthew D Jose, Keshav Bhattarai, Carmel Fenton, Rajiv Sharma, Geoff Kirkland, Lisa Jeffs, Monique Breslin, Bruna Silva Ragaini and Richard F Newland in Perfusion

Research paper thumbnail of Infectious complications in the Southern Tasmanian kidney transplant population

Nephrology, 2019

This is the author manuscript accepted for publication and has undergone full peer review but has... more This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Research paper thumbnail of Abo-Incompatible Renal Transplantation Without Splenectomy or Rituximab – Excellent Renal Function and Graft Histology

Transplantation, 2008

Masterson et al had shown that in their series of 20 patients with low blood group antibody titer... more Masterson et al had shown that in their series of 20 patients with low blood group antibody titers (ABGAb) who underwent ABO-incompatible (ABOi) live donor renal transplantation with standard immunosuppression and without antibody removal had 100% patient and graft survival at the end of 36 months (1). We report two patients from our centers who received ABOi live donor renal transplantation with low-level ABGAb with standard immunosuppression and no antibody removal, but with opposite results.

Research paper thumbnail of Chronic kidney disease in Tasmania

Nephrology, 2009

Chronic kidney disease (CKD) is a progressive disease which is becoming a major public health iss... more Chronic kidney disease (CKD) is a progressive disease which is becoming a major public health issue due to its high rate of premature death, poor quality of life and expensive end-stage treatment (dialysis or transplantation). The burden of this chronic condition in a community setting was examined. Data were obtained from 369,098 Tasmanian adults (aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=18 years) and included 1,640,687 measurements of creatinine taken between 1995 and 2007. In 2007 alone, testing comprised 25.5% of the state&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s adult population. A modelled estimate of CKD prevalence was developed. For those at risk of CKD (aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50 years), 50.6%, 70.2% and 82% had a measured creatinine (and reported estimated glomerular filtration rate (eGFR)) during the last 1, 2 and 3 years respectively. However, only 9.4% of people with eGFR of less than 60 mL/min per 1.73 m(2) had albuminuria formally measured. Estimated prevalence of stage III or greater CKD (eGFR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;60 mL/min per 1.73 m(2)) was at least 11.4% of women and 8.6% of men during 2007. Detection of low eGFR increased significantly over the last 13 years. There was a large geographic variation throughout Tasmania and high relative mortality with lower eGFR. There is a broad gap between the number of people with eGFR of less than 15 mL/min per 1.73 m(2) (stage V CKD) and those receiving dialysis treatment. The number of people identified with low eGFR has increased significantly since 1995 with a large geographic variation. Despite this, testing for kidney disease (by measuring serum creatinine and albuminuria) in people at risk is still suboptimal.

Research paper thumbnail of Snake venom allergy

Medical Journal of Australia, 1990

Research paper thumbnail of Acute granulomatous interstitial nephritis in a patient with metastatic melanoma on targeted therapy with dabrafenib and trametinib — A case report

Cancer Reports

BACKGROUND Combination molecular targeted therapy with dabrafenib plus trametinib has been shown ... more BACKGROUND Combination molecular targeted therapy with dabrafenib plus trametinib has been shown to improve progression-free survival and overall survival in patients with BRAF V600 mutated unresectable or metastatic melanoma. In general, these agents are well tolerated. Kidney related adverse events are uncommon with only three case reports of acute interstitial nephritis and one case of a serious acute kidney injury. We report another case of interstitial nephritis related to these drugs. CASE A 37-year-old man diagnosed with metastatic melanoma (BRAF V600E mutation) who developed acute interstitial nephritis 5 years into his treatment with combination dabrafenib plus trametinib therapy. He presented with an asymptomatic acute kidney injury on routine surveillance pathology with a creatinine of 174 μmol/L (from baseline 80 μmol/L) and a corresponding estimated glomerular filtration rate (eGFR) of 42 ml/min/1.73 m2 (from a baseline >90 ml/min/1.73 m2 ) and microalbuminuria (albumin creatinine ratio [ACR] 8.5 mg/mmol). Renal biopsy revealed a granulomatous interstitial nephritis likely drug related. He was treated with prednisolone 1 mg/kg and ceased his targeted therapy with improvement in his renal function. CONCLUSION Although rare, recognition of acute interstitial nephritis, a possible serious adverse outcome due to dabrafenib and trametinib is important and needs to be incorporated into current Australian cancer therapy guidelines.

Research paper thumbnail of Acute kidney injury, stroke and death after cardiopulmonary bypass surgery: the role of perfusion flow and pressure

Perfusion

Introduction: Acute kidney injury after cardiopulmonary bypass surgery is associated with morbidi... more Introduction: Acute kidney injury after cardiopulmonary bypass surgery is associated with morbidity and mortality. This study aims to evaluate the role of low perfusion flow and pressure in the development of cardiopulmonary bypass–associated acute kidney injury, stroke and death, using multicentre registry data. Methods: We identified patients from the Australian and New Zealand Collaborative Perfusion Registry who underwent coronary artery bypass grafting and/or valvular surgery between 2008 and 2018. Primary predictor variables were the length of time the perfusion flow was <1.6 L/min/m2 and the length of time perfusion pressure was < 50mmHg. The primary outcome was new postoperative acute kidney injury defined by the risk-injury-failure-loss-end stage criteria. Secondary outcomes were stroke and in-hospital death. The influence of perfusion flow and pressure during cardiopulmonary bypass on the primary and secondary outcomes was estimated using separate multivariate models...

Research paper thumbnail of Genetic Kidney Disease in Southern Tasmania

Kidney International Reports

SUPPLEMENTARY MATERIAL Supplementary File (Word) Supplementary References. Supplementary Methods.... more SUPPLEMENTARY MATERIAL Supplementary File (Word) Supplementary References. Supplementary Methods. Table S1. Patient characteristics, previous peritonitis, laboratories, and outcome. Table S2. Accuracy of serum galactomannan index for differentiating fungal peritonitis at different cutoff points.

Research paper thumbnail of Assessment of current practice and barriers to antimicrobial prophylaxis in peritoneal dialysis patients

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Jan 22, 2015

Existing Australasian and international guidelines outline antibiotic and antifungal measures to ... more Existing Australasian and international guidelines outline antibiotic and antifungal measures to prevent the development of treatment-related infection in peritoneal dialysis (PD) patients. Practice patterns and rates of PD-related infection vary widely across renal units in Australia and New Zealand and are known to vary significantly from guideline recommendations, resulting in PD technique survival rates that are lower than those achieved in many other countries. The aim of this study was to determine if there is an association between current practice and PD-related infection outcomes and to identify the barriers and enablers to good clinical practice. This is a multicentre network study involving eight PD units in Australia and New Zealand, with a focus on adherence to guideline recommendations on antimicrobial prophylaxis in PD patients. Current practice was established by asking the PD unit heads to respond to a short survey about practice/protocols/policies and a 'proces...

Research paper thumbnail of Heparin-binding EGF-like growth factor mRNA is upregulated in the peri-infarct region of the remnant kidney model: in vitro evidence suggests a regulatory role in myofibroblast transformation

Journal of the American Society of Nephrology : JASN, 1998

Heparin-binding epidermal growth factor-like growth factor (HB-EGF) is a potent fibroblast and ep... more Heparin-binding epidermal growth factor-like growth factor (HB-EGF) is a potent fibroblast and epithelial cell mitogen that may be important in wound healing. The aim of this study was to determine its distribution and possible function in segmental renal infarction. At day 1 postinfarction, in situ hybridization showed that HB-EGF mRNA was markedly increased by tubular epithelial cells bordering the infarcted zone. At day 3, typical myofibroblasts expressing alpha-smooth muscle actin (alpha-SMA) were present in large numbers at the peri-ischemic border and, over succeeding days, were also seen within the infarcted area. Some of these cells expressed HB-EGF mRNA by in situ hybridization suggesting possible autocrine stimulation. Endothelial cells appeared to be more resistant to ischemia than tubules because some capillaries at the periphery of the infarct, surrounded by infarcted tubules, also expressed HB-EGF mRNA. The staining intensity of HB-EGF mRNA in individual tubules and en...

Research paper thumbnail of Classical polyarteritis nodosa and microscopic polyarteritis with medium vessel involvement--a comparison of the clinical and laboratory features

Clinical nephrology, 1997

Microscopic polyarteritis may involve medium-sized and small blood vessels as well as arterioles,... more Microscopic polyarteritis may involve medium-sized and small blood vessels as well as arterioles, venules and capillaries. We have compared the clinical and laboratory features in patients with microscopic polyarteritis and medium vessel involvement, with the features found in patients with polyarteritis nodosa affecting medium vessels alone. In a 9-year period, 21 patients presented to our hospital with a form of polyarteritis. Seven had microscopic polyarteritis demonstrated histologically (6/7, 86%) and associated with dysmorphic urinary red cells (7/7, 100%), as well as medium vessel vasculitis demonstrated histologically (7/7) or by angiography (1/7, 14%). Five patients had polyarteritis nodosa with medium vessel vasculitis demonstrated histologically (3/5, 60%) or by angiography (2/5, 40%); and no evidence of a glomerular vasculitis on biopsy (2/7, 29%) or in the urinary sediment (0/7, 0%). The remaining 9 patients had microscopic polyarteritis but medium vessel involvement wa...

Research paper thumbnail of ABO-INCOMPATIBLE RENAL TRANSPLANTATION WITHOUT SPLENECTOMY OR RITUXIMAB – EXCELLENT RENAL FUNCTION AND GRAFT HISTOLOGY

Research paper thumbnail of Factors Associated with Chronic Kidney Disease Progression in Australian Nephrology Practices

Nephron Clinical Practice, 2012

rapid decline in eGFR (p = 0.007, 0.033, and 0.003, respectively). On multivariate analysis: gend... more rapid decline in eGFR (p = 0.007, 0.033, and 0.003, respectively). On multivariate analysis: gender, age, prescription of ESA and phosphate binders, and baseline eGFR were significantly associated with CKD progression (p = 0.003, 0.004, ! 0.001, 0.029, and ! 0.001, respectively). Conclusions: This study identifies potential factors associated with CKD progression in a population referred to nephrologists, but current data quality may result in bias. Implementation of changes in the format of data collection is required so that busy clinicians record essential information to enable this to become a more accurate and reliable research tool.

Research paper thumbnail of Darbepoetin alfa administered monthly maintains haemoglobin concentrations in patients with chronic kidney disease not receiving dialysis: A multicentre, open-label, Australian study

Nephrology, 2007

Darbepoetin alfa, an erythropoiesis-stimulating protein, has a longer serum half-life than recomb... more Darbepoetin alfa, an erythropoiesis-stimulating protein, has a longer serum half-life than recombinant human erythropoietin, allowing less-frequent administration. This study aimed to demonstrate that once-monthly (QM) darbepoetin alfa administration would maintain haemoglobin (Hb) concentrations in subjects with chronic kidney disease (CKD) not receiving dialysis who had previously been administered darbepoetin alfa every 2 weeks (Q2W). Methods: This was a multicentre study in which subjects with CKD receiving stable Q2W darbepoetin alfa doses and with stable Hb (100-130 g/L) were started on QM darbepoetin alfa dosing. The initial QM darbepoetin alfa dose was equivalent to the cumulative darbepoetin alfa dose administered during the month preceding enrolment. Darbepoetin alfa doses were titrated to maintain Hb concentrations between 100 and 130 g/L. The primary endpoint was the proportion of subjects maintaining mean Hb 3 100 g/L during the evaluation period (weeks 21-33). Results: Sixty-six subjects were enrolled in the study and all received at least one dose of darbepoetin alfa; 55 (83%) had mean Hb 3 100 g/L during evaluation. Mean (SD) Hb concentrations at baseline and during the evaluation period were 119 (8.7) g/L and 114 (9.8) g/L, respectively. The median QM darbepoetin alfa dose at baseline and during the evaluation period was 80 mg. Darbepoetin alfa was considered to be well-tolerated. Conclusion: Patients with CKD not receiving dialysis who are receiving darbepoetin alfa Q2W can be safely and effectively extended to darbepoetin alfa QM. Dosing QM may simplify anaemia management for patients and health-care providers.

Research paper thumbnail of Upregulation of heparin-binding epidermal growth factor-like growth factor and osteopontin in experimental hydronephrosis

Research paper thumbnail of Exercise intolerance in Kearns-Sayre syndrome

Journal of Clinical Neuroscience, 1996

Exercise intolerance is a common finding in mitochondrial diseases, including Kearns-Sayre syndro... more Exercise intolerance is a common finding in mitochondrial diseases, including Kearns-Sayre syndrome (KSS), characterised by progressive external ophthalmoplegia, cardiac conduction defects and atypical pigmentary degeneration of the retina. Exercise studies were performed in a 32 year old woman with KSS who had received an atrio-ventricular sequential pacemaker because of continuing breathlessness, having presented with complete heart block requiring a fixed rate demand pacemaker 6 years earlier. Minute ventilation, oxygen consumption, and carbon dioxide production were measured at different workloads on 3 consecutive days by collecting expired air. Compared to controls, after exercise at a subanaerobic workload, heart rate and ventilation were exaggerated relative to both oxygen consumption and carbon dioxide production. The findings are consistent with the hypothesis that, in mitochondrial disorders, impaired oxidative phosphorylation leads to uncoupling of cardiac ouput and ventilation relative to muscle metabolic rate.

Research paper thumbnail of Heparin Binding Epidermal Growth Factor-like Growth Factor Is a Transforming Growth Factor β-Regulated Gene in Intestinal Epithelial Cells

Biochemical and Biophysical Research Communications, 1999

Research paper thumbnail of Polyarteritis nodosa and Antiglomerular Basement Membrane Disease without Antineutrophil Cytoplasm Antibodies

American Journal of Nephrology, 1996

Antiglomerular basement membrane (GBM) antibodies have been described previously in patients with... more Antiglomerular basement membrane (GBM) antibodies have been described previously in patients with microscopic polyarteritis but not in patients with polyarteritis nodosa alone. Where anti-GBM antibodies occur in microscopic polyarteritis, antineutrophil cytoplasm antibodies (ANCA) are usually present. We describe here a patient with polyarteritis nodosa and anti-GBM antibodies in whom ANCA could not be demonstrated. A 72-year-old woman presented with abdominal pain, diarrhoea and acute renal failure. A renal biopsy showed crescentic glomerulonephritis and linear immunofluorescence of the GBM consistent with anti-GBM disease. In addition, there was evidence of large-and medium-sized vessel vasculitis on abdominal angiography, performed because of persisting abdominal pain. There was no small vessel vasculitis on histological examination of the renal biopsy and ANCA could not be demonstrated by indirect immunofluorescence or ELISA.

Research paper thumbnail of Cutaneous necrosis from calcific uremic arteriolopathy

American Journal of Kidney Diseases, 1998

Research paper thumbnail of Chronic kidney disease in Tasmania

Nephrology, 2009

Chronic kidney disease (CKD) is a progressive disease which is becoming a major public health iss... more Chronic kidney disease (CKD) is a progressive disease which is becoming a major public health issue due to its high rate of premature death, poor quality of life and expensive end-stage treatment (dialysis or transplantation). The burden of this chronic condition in a community setting was examined. Data were obtained from 369,098 Tasmanian adults (aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=18 years) and included 1,640,687 measurements of creatinine taken between 1995 and 2007. In 2007 alone, testing comprised 25.5% of the state&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s adult population. A modelled estimate of CKD prevalence was developed. For those at risk of CKD (aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50 years), 50.6%, 70.2% and 82% had a measured creatinine (and reported estimated glomerular filtration rate (eGFR)) during the last 1, 2 and 3 years respectively. However, only 9.4% of people with eGFR of less than 60 mL/min per 1.73 m(2) had albuminuria formally measured. Estimated prevalence of stage III or greater CKD (eGFR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;60 mL/min per 1.73 m(2)) was at least 11.4% of women and 8.6% of men during 2007. Detection of low eGFR increased significantly over the last 13 years. There was a large geographic variation throughout Tasmania and high relative mortality with lower eGFR. There is a broad gap between the number of people with eGFR of less than 15 mL/min per 1.73 m(2) (stage V CKD) and those receiving dialysis treatment. The number of people identified with low eGFR has increased significantly since 1995 with a large geographic variation. Despite this, testing for kidney disease (by measuring serum creatinine and albuminuria) in people at risk is still suboptimal.