2023 Post-doctoral Clinical Fellowship
Cerebrovascular physiology, cerebral microembolism and patent foramen ovale in the critically ill with acute kidney injury
Impaired kidney function is strongly associated with increased risk of stroke and dementia. Some of this risk may relate to dialysis which is a procedure that removes waste products and excess fluid from the blood when the kidneys stop working properly. This is a therapy that is frequently required in the intensive care unit (ICU) for patients who are critically ill. However, it is not known how dialysis affects the blood flow in the brain, whether it may generate some small air bubbles that reach the brain during the dialysis session and whether these events may subsequently increase the risk of stroke.
Therefore, the aim of our study is to investigate the impact of continuous dialysis therapy on brain blood flow in a group of patients with acute kidney injury in the ICU. We will explore whether these dialysis sessions generate frequent air bubbles in the brain and whether there is then a higher risk of stroke or delirium in this setting.
We will include all critically ill patients treated with continuous dialysis in the general ICU and neurocritical care unit in the John Radcliffe Hospital, Oxford, between the 1st September 2023 and 1st September 2024. We will perform transcranial Doppler ultrasound measurements during the dialysis sessions. This is a non-invasive test that uses sound waves to examine blood flow in the brain. We will also perform some routine clinical examinations to evaluate for neurological and cognitive disturbances. We will record any stroke or delirium events that may occur as well as the results of brain imaging tests performed.
Since up to one in four patients in the ICU are in receipt of continuous dialysis therapy, this study will address an important gap in our knowledge. If we uncover a negative impact of dialysis on brain health, we will need to conduct larger studies and trials to find ways to make dialysis safer for patients in the future.
Guideline contribution
Member of the European Society of Cardiology Task Force for the upcoming Chronic Kidney Disease in Cardiovascular Disease Guidelines (publication expected 2026 Q3), with concurrent publications planned in the European Heart Journal and Nephrology Dialysis Transplantation.
Prizes
ERA Eberhard Ritz Award for Young Investigators in Clinical Science, European Renal Association, 2025
Publications
Acute Kidney Injury and Risk of Adverse Neurocognitive Outcomes: A Systematic Review and Meta-analysis
Neurology
2026
Global environmental change and the gut–kidney–brain axis: a review and framework of vulnerability and resilience
Lancet Planetary Health
2026
Acute Febrile Encephalopathy with Rigidity
Journal of Intensive Care Medicine
30 May 2025
Global access to medications and health technologies for kidney care: A multinational study from the ISN-GKHA
PLOS Global Public Health
10 February 2025, https://doi.org/10.1371/journal.pgph.0004268
Assessing the role of education level on climate change belief, concern and action: a multinational survey of healthcare professionals in nephrology
Journal of Nephrology
29 January 2025
The Kidney-Immune-Brain Axis: the Role of Inflammation in the Pathogenesis and Treatment of Stroke in CKD
Stroke
24 January 2025
Age- and sex-specific analysis of stroke hospitalization rates, risk factors and outcomes from German nationwide data
Stroke
September 2024
Climate Change, Kidney Health, and Environmentally Sustainable Kidney Care
Journal of the American Society of Nephrology
August 2024, DOI: 10.1681/ASN.0000000000000402
Capacity for the management of kidney failure in the International Society of Nephrology Western Europe region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)
Kidney International Supplements
April 2024, DOI: 10.1016/j.kisu.2024.01.008
Interplay Between Chronic Kidney Disease, Hypertension, and Stroke: Insights from a Multivariable Mendelian Randomization Analysis
Neurology. 2023 Nov 14;101(20):e1960-e1969
2023
Kidney Function, Albuminuria, and Risk of Incident Atrial Fibrillation: A Systematic Review and Meta-analysis
American Journal of Kidney Diseases 2023 Sep 29:S0272-6386(23)00839-9
2023
Stroke Subtype Among Individuals with Chronic Kidney Disease
Canadian Journal of Kidney Health and Disease 2023 Oct 14;10:20543581231203046
2023