Epsom and St Helier doctor leads 3.9 million trial

A team of researchers led by a renal consultant at Epsom and St Helier hospitals has been awarded a prestigious research grant of £3.9 million to determine whether aspirin should be prescribed to people with kidney disease to help prevent heart attacks and strokes.

The research is being funded the National Institute for Health Research (NIHR) and the British Heart Foundation, and is thought to be the largest study of its kind in kidney patients. The team will look to recruit 23,000 people across the country in order to determine if a low dose of aspirin should be used to prevent a first heart attack and stroke in people with chronic kidney disease. The study, which will be known as ‘Aspirin To Target Arterial Events in Chronic Kidney Disease’ (ATTACK), will be led by Dr Hugh Gallagher from Epsom and St Helier.

Dr Gallagher said: “It is estimated that there are at least five million people with chronic kidney disease in the UK, and although only a minority will develop kidney disease of such severity that dialysis or a transplant is required, all are at increased risk of cardiovascular disease (a general term for conditions including heart attack, angina and stroke).

“Finding new ways to reduce cardiovascular risk is perhaps the most important task facing renal researchers internationally. Aspirin is a familiar and inexpensive intervention and there is some evidence that people with kidney disease may particularly stand to benefit, but there is also the potential for extra risks of bleeding. We believe that around one million people with chronic kidney disease who do not have cardiovascular disease are now prescribed aspirin to prevent a first heart attack or stroke whereas three million are not, reflecting the current uncertainty.

“To find out whether aspirin is effective and safe in this group, collaboration is needed between primary care, public health and hospital specialists. We are working closely with Professor Paul Roderick (public health) and Professor Michael Moore (general practice) at the University of Southampton as well as other experts from primary care, renal medicine, cardiology and gastroenterology.

“This trial should give us the evidence required to prove one way or the other whether we should be offering aspirin to our patients with chronic kidney disease to prevent heart disease.”

Joint Medical Director Dr James Marsh said: “We are all so incredibly proud of Hugh and the research team for securing this vital funding. This debate around aspirin for patients with chronic kidney disease has rumbled on for some years, with doctors up and down the country taking a different approach. We hope that this clinical trial will give us a clear answer once and for all, and we are absolutely delighted that Epsom and St Helier staff will be at the forefront of that work.”

The study follows a recommendation from the National Institute for Health and Care Excellence (NICE) in 2014 that a definitive trial of aspirin in CKD was needed, and the team from St Helier, Southampton, Nottingham, Derby, Kent, Warwick and Durham have been working together to develop the research plan over the last three years. ATTACK is sponsored by the University of Southampton.

Recruitment is expected to begin in the summer of 2018, and the trial is scheduled to finish in 2025.