Renal Medicine and Medical Interventions in Older People awarded £1.6M funding

Our Kidney Disease HIT co-director Dr Barny Hole is an NIHR Academic Clinical Lecturer in Health Needs of Older People: Renal Medicine, and an Honorary Research Associate at the University of Bristol. Dr Hole has recently been awarded an NIHR Advanced Fellowship of over £1.6 million to fund a project titled “You’ve got to decide whether that’s worth it”. How do older people decide between initiation and non-initiation of burdensome, potentially life-prolonging treatments, and how can they be better supported? A mixed methods study.

Disease management

The project follows on from Dr Hole’s previous research, which investigated how older people decided whether or not to prepare for dialysis. His work has demonstrated that patients would accept shorter lives if their independence was protected and their treatment burden – time lost, hospital visits, intrusion into the home and so on – was decreased. Family members played a crucial part in this decision making process. Barny said:

“My work highlights the need for health services that offer greater individualisation and choice, prioritise independence, and minimise intrusion from treatment. But it leaves important questions: i) were the trade-offs elicited unique to participants considering kidney failure, or did I inadvertently capture higher-level preferences amongst older people living with multiple long-term conditions? and ii) were participants’ preferences fixed, or will they change over time?”

Barny’s Advanced Fellowship will answer some of these questions.

Lockdown award

During the Covid lockdowns, Barny suspended his research to return to NHS frontline work. On his return, The Elizabeth Blackwell Institute supported Barny with an Early Career Research Covid mitigation support award. This award aimed to support researchers’ projects and their careers following disruption by COVID-19 and was open to early career researchers in health research. Funding was given to projects disrupted due to caring responsibilities, work duties or other circumstances.

“This award reflected a drive to develop an alternative research idea for my PhD when COVID-19 struck. I was unsure whether I would be able to undertake the research originally planned for my PhD, but as it happened, both what I planned and this alternative project were possible – only because of the support provided by the EBI! I am confident that this support and the findings from this work will greatly enhance my contribution to the literature – and ultimately to patient care.”

Barny’s project investigated the number of UK adults who developed kidney failure since 2000. The award allowed him to apply for access to NHS primary care and hospital data. It also provided funding for an analyst, who used the data to describe adult and child outcomes, and compared the care of individuals who did and did not receive dialysis. Barny’s group will present the findings of this work at the upcoming World Congress of Nephrology, and a research paper is due out soon.

“This is important work that has not been attempted before in this country. The importance is highlighted in the report released recently by Kidney Research UK, Kidney disease: A UK Public Health Emergency. Whist the report described the costs of care to those with kidney failure treated with dialysis, it was not able to include those who receive non-dialysis conservative kidney management. This is a major omission and the evidence gap will be closed by the work funded by EBI.”