Nephrology, Dialysis and Transplantation

Group leader

Principal Investigator

Team members

Ana Castro, MD

Clinical researcher

    Ana P. Bernardo, MD, PhD

    Integrated PhD researcher

      Ana Rocha, MD

      Clinical researcher

        Bernardete Pessoa, MD

        PhD Student

          Carla Moreira, MD

          Clinical researcher

            Idalina Beirão, MD, PhD

            Integrated PhD researcher

              Isabel Fonseca, PhD

              Integrated PhD researcher

                João Beirão, MD, PhD

                Integrated PhD researcher

                  Jorge Dores, MD

                  Clinical researcher

                    Jorge Malheiro, MD, PhD

                    Integrated PhD researcher

                      Josefina Santos, MD

                      PhD Student

                        La Salete Martins, MD, PhD

                        Integrated PhD researcher

                          Luísa Lobato, M.D., Ph.D.

                          Vice-Coordinator

                          DEFI Director, Integrated PhD researcher

                            Manuela Almeida, MD

                            Consultant

                              Maria João Carvalho, MD

                              Clinical researcher

                                Ramón Vizcaíno, MD

                                Clinical researcher

                                  Sandra Tafulo, MSc

                                  PhD Student

                                    Sofia Pedroso, MD

                                    Clinical researcher

                                      Sofia Santos, MD

                                      Clinical researcher

                                        Introduction

                                        NDT was integrated in UMIB in 2007, when nephrologists from Hospital de Santo António, Centro Hospitalar Universitário do Porto (CHUP, www.chporto.pt), motivated by specific investigation, felt the need to have a comprehensive partnership from basic science.

                                        The research in the field of Nephrology in Portugal is particularly important. Our country has one of the highest prevalence rates of renal replacement therapy in Europe, with obligatory growing economic burden.

                                        The research group results from a balanced cooperation between nephrologists and clinical researchers, interacting with biochemists and geneticists. Our goals are to improve the diagnosis, treatment and prognosis of renal diseases, investigate their causes, mechanisms of initiation and progression.

                                        The specific research aims include:

                                        • In the area of nephropathic amyloidosis the goal is to study epidemiology, genetics, pathology and treatment of these disorders. We aim to detect preclinical renal injury through biomarkers especially using urinary proteomics; in transthyretin amyloidois (ATTR) and in fibrinogen A-alpha chain amyloidosis (AFib) the purposes are to study the effect of age and gender on severity of nephropathy.
                                        • In the area of peritoneal dialysis (PD), to study the metabolic changes associated with PD and their repercussion, at both systemic and peritoneal levels. The specific objectives include to assess the body composition changes in patients under different schemes of PD and their correlation with the profile of peritoneal transport, glucose exposure, cardiovascular risk, cardiovascular events and mortality.
                                        • In the Transplantation field the aims are to study the factors that limit the long-term success of renal transplantation and the clinical outcome of renal and pancreatic transplant recipients.

                                        The investigation is dedicated to the complex interaction between chronic kidney, genetics, metabolic syndrome, and diabetes. The researchers have a great ability to scope the natural history of systemic and renal disorders, involving clinical nephrology, peritoneal dialysis and solid organs transplantation. Although specific research fields of the group are diverse, the mechanisms of renal pathology and genetics investigated in General Nephrology can be easily shared by our team of Dialysis & Transplantation.

                                        Our work shares investigation with other groups of UMIB particularly with Clinical and Experimental Human Genomics and Clinical and Experimental Endocrinology. To pursue these objectives, the group has the possibility of developing research lines in the clinical nephrological division of CHUP. Founded in 1974, the Department of Nephrology of CHUP is one of leading group in Portugal for kidney diseases and the unique with Programme of Pancreas transplantation in Portugal.

                                        The Department of Nephrology has active inpatient and outpatient consultant services with an extensive connection network of dialysis units located in the Porto district. Inpatient activity involves over 600 patients yearly, including about 90 isolate kidney and simultaneous kidney/pancreas from cadaveric and living donors. The Transplantation Programme has over 2300 kidney transplants and over 170 simultaneous kidney-pancreas. Comprehensive outpatient services comprise over 17.000 consults yearly, with a Peritoneal Dialysis Programme with 75 patients on manual and automated home peritoneal dialysis. Regarding amyloidosis we provide facilities to local patients, national and international. Nephrologists of NDT group are integrated in Unidade Corino de Andrade of CHUP, particularly dedicated to transthyretin amyloidosis.


                                        Aims

                                        Immunobiology of renal transplantation:
                                        • Evaluation of the clinical impact of preformed antiHLA-Cw vs antiHLA-A and/or -B donor-specific antibodies (DSA) in kidney transplantation _ concluded that DSA-Cw are associated with an identical risk of antibody mediated rejection and impact on graft function in comparison with “classical” class I DSA.
                                        • Testing the detrimental impact of preformed anti-HLA donor-specific antibodies (DSA) and non-donor-specific antibodies (NDSA), multivariable competing risk analysis confirmed both NDSA and DSA as significant predictors of graft failure.
                                        Epidemiology of CKD:
                                        • By using a competing-risk analysis to identify prognostic markers for ESRD or death in elderly CKD it was shown that elderly referred patients with CKD are near threefold more likely to die than progress to ESRD.
                                        Pancreas Transplantation outcomes – testing the effect of dialysis modality prior to SPKT (simultaneous pancreas-kidney transplantation) comparing peritoneal dialysis (PD) and hemodialysis (HD) groups:
                                        • PD patients more frequently complicated with intra-abominal infection leading to pancreatic loss and with renal thrombosis, with adverse impact on survival.
                                        Metabolic complications in peritoneal dialysis:
                                        • Insulin resistance was evaluated with homeostasis model assessment method (HOMA-IR). HOMA-IR correlated with HOMA-AD, but did not correlate with glucose absorption or transport rate. Insulin resistance in nondiabetic peritoneal dialysis patients is associated with obesity and LAR

                                        Highlighted publications

                                        1. Malheiro, J.; Tafulo, S.; Dias, L.; Martins, L.S.; Fonseca, I.; Beirão, I.; Castro‐Henriques, A.; Cabrita, A. Determining donor‐specific antibody C1q‐binding ability improves the prediction of antibody‐mediated rejection in human leucocyte antigen‐incompatible kidney transplantation. Transplant International 2017, 30, 347-359. doi: 10.1111/tri.12873
                                        2. Santos J,Fonseca I,Malheiro J, Beirao I, Lobato L, Oliveira P, Cabrita A .End-stage renal disease versus death in a Portuguese cohort of elderly patients: an approach using competing event analysis.J Investig Med. 2017 Oct;65(7):1041-1048. doi: 10.1136/jim-2017-000480
                                        3. Bernardo AP, Oliveira JC, Santos O, Carvalho MJ, Cabrita A, Rodrigues A. Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients: Associations with Body Composition, Peritoneal Transport, and Peritoneal Glucose Absorption. Clin J Am Soc Nephrol. 2015 December, 10(12);2205-2212. doi: 10.2215/CJN.03170315

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