The story of cholesterol-lowering in kidney disease: from hypothesis to meta-analysis
Thirty years ago there was a great deal of uncertainty about whether higher levels of circulating blood cholesterol were a good or bad thing in patients with chronic kidney disease.
Colin began studying this issue as a MSc student at the London School of Hygiene and Tropical Medicine, and his thesis turned into a 450 patient pilot randomized trial in the UK, and from there into the international 9,000 patient Study of Heart and Renal Protection (The George Institute was a major collaborator), which was completed in 2011. This study showed that, as in other populations at risk of atherosclerosis, too much cholesterol is a bad thing. But there were questions even after the trial had been completed, and so Colin and team went on to look at an individual patient data meta-analysis of all statin trials to try to understand why treatment was less effective (and perhaps ineffective) in dialysis patients.
During this seminar, Colin will describe the journey from hypothesis to the present day, touching on lessons learnt and how they have influenced his current research direction, as well as describing why (in his view) some current research trends in nephrological trials are inimical to patient interests.
Professor Colin Baigent is Director of the MRC Population Health Research Unit and Deputy Director of the Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU) at the University of Oxford, where he is Professor of Epidemiology. He has led some of the world’s largest collaborative meta-analyses of randomized trials, typically with individual participant data, resulting in landmark papers that have helped determine, for example, the effects of statins and aspirin in different types of people. His group is now coordinating the EMPA KIDNEY trial, a trial comparing empagliflozin versus placebo in 5000 patients with chronic kidney disease, which is designed to assess the effects of empagliflozin on progression to ESRD or cardiovascular death.