The Kidney Foundation of Canada

Dr. Christopher McIntyre 

Dr. Christopher McIntyre

Lawson Health Research Institute, Ontario

Understanding the pathophysiology of uremic symptoms: A pilot mechanistic study of dialysate cooling to protect against hemodialysis induced liver and gut dysfunction

2017-2019:  $100,000  | Biomedical Research Grants  |  Category: Dialysis


Dr. McIntyre is Professor of Medicine, Professor of Medical Biophysics, Professor of Paediatrics and Robert Lindsay Chair of Dialysis Research and Innovation at Western. He also serves as Director of the Lilibeth Caberto Kidney Clinical Research Unit at London Health Sciences Centre, where he is also a practicing Clinical Nephrologist. He leads a team of multidisciplinary researchers focused largely on the pathophysiology of the effecting cardiovascular, brain, liver and gastro-intestinal structure and function in patients with chronic kidney disease. These studies include basic clinical science, natural history studies and the development and application of novel therapeutic strategies into large scale randomized controlled trials. These studies have increasingly focused on the adverse consequences resulting from dialysis therapy itself and the improvement in outcomes by the reduction of preventable harm. Multimodal imaging plays an important role in these studies including ultrasound, CT, PET and MRI.

Research Areas: Hemodialysis, Applied Imaging (CT, MRI, PET, Imaging), Chronic Kidney Disease, Peritoneal Dialysis, Cardio Renal Medicine

Lay Summary

An alarming 24, 000 Canadians (and over two million people worldwide) suffer from serious kidney failure and rely on a dialysis machine to clean their blood. Dialysis poses significant challenges; one in three patients die within a year of starting dialysis and those who undergo long-term dialysis treatment experience an array of adverse symptoms. For example toxins, which would have normally been removed by the kidneys, can cause itch and other unpleasant effects. Some of these toxins come from the gut, and should normally be partially processed by the liver before they even get to the rest of the body. However, if the liver does not work properly, the patient’s blood can be flooded with more toxins than dialysis can eliminate.

Dialysis has been shown to cause damage to different organs (such as the heart, brain, intestine and kidney). We propose that dialysis also leads to liver damage, starving it of blood to the point where it cannot manage the breakdown of these toxins coming from the gut, and resulting in a buildup of toxins in the blood. To investigate this, we will examine the function and blood supply of the liver using a special form of CT scanner, and compare the condition of the liver to the symptoms experience by dialysis patients. We will then examine whether changes in the dialysis treatment can help improve liver function, by maintaining sufficient blood supply. We have previously shown that the safe and simple measure of cooling the dialysis fluid is effective at protecting other organs from damage, such as the heart and brain.

This study will be the first to examine the role of the liver in dialysis. It will provide entirely new insights into the reasons why dialysis patients experience undesirable symptoms and allow us to uncover new ways to improve these symptoms by focusing on modifying dialysis treatment.