The work of CKR covers all aspects of research, from basic to clinical and population health. This includes studies looking at genetic kidney diseases and also rejection and tolerance of kidney transplants.
The Centre has recently completed the world's largest study investigating the effect of long-term antibiotics on urinary tract infections in children, the PRIVENT trial. This multi-centred trial was conducted over 10 years, providing long-awaited evidence for practitioners that this treatment is effective.
New diagnostic methods for children with serious bacterial illness in the emergency room have been trialled in the FEVER Study, with outcomes currently being analysed.
The Centre is also involved in investigating bed-wetting and childhood daytime wetting. The NEAT Study tested the effectiveness of a new wireless bed-wetting alarm device developed by the research team, which proved successful. Also the WATCH Study is currently assessing timed voiding in children to treat daytime incontinence, and eADVICE is a web based interactive treatment tool which is being piloted in children with incontinence, to help them while they wait to see a continence Specialist.
Targeting risk factors that lead to kidney disease in the general population and high risk groups is also an important part of the Centre's work. Aboriginal Australians have a nine times the incidence of end-stage renal disease than non-Aboriginals. The Antecedents of Renal Disease in Aboriginal Children (ARDAC) Study is concerned with addressing this issue.
In addition, the Centre has been involved with Cochrane Kidney and Transplant, which is responsible for coordinating a database of all studies relating to kidney disease in adults and children. It has also produced the Caring for Australasians with Renal Impairment (CARI) Guidelines for nephrologists.
One of the world's largest studies investigating the effect of long-term antibiotics on urinary tract infections in children was coordinated from the CKR. This multi-centred trial was conducted over 10 years, providing long-awaited evidence for practitioners.
PRIVENT was an NHMRC funded, multicentre, blinded, randomised controlled trial designed to determine whether long-term antibiotics prevents urinary tract infection in children. Antibiotics or placebo were given daily to the children over 1 year and investigators, pharmacy staff and outcome assessors were blind to the treatment allocation. PRIVENT was the first large scale study investigating whether long-term antibiotics prevent urinary tract infections in children.The results of this study were published in 2009 and were followed 5 years later with a large scale study from the United States demonstrating very similar findings. Agreement between these two well designed trials provides convincing evidence of the size of the benefit of antibiotic prophylaxis in children at risk of repeat urinary tract infection.
The results of this study have now been published.
Craig JC, Simpson JM, Williams G, Reynolds G, McTaggart S, Hodson E, Carapetis j, Cranswick N, Irwig L, Caldwell P, Roy LP. Antibiotic Prophylaxis and Recurrent Urinary Tract Infection in Children. New England Journal of Medicine 2009 Oct 29;361(18):1748-59. Free full text
New diagnostic methods for children with serious bacterial illness in the emergency room have been trialled in the FEVER Study.
Published papers from this study include:
Craig JC, Williams GJ, Jones M, Codarini M, Macaskill P, Hayen A, Irwig L, Fitzgerald DA, Isaacs D, McCaskill M. The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrileillnesses.BMJ. 2010 Apr 20;340:c1594. doi: 10.1136/bmj.c1594 Free full text
Targeting risk factors that lead to kidney disease in the general population and high risk groups is also an important part of CKR’s work. Research has found that Aboriginal Australians have a 9-fold increase of end-stage renal disease than non-Aboriginals. The Antecedents of Renal Disease in Aboriginal Children (ARDAC) Study is concerned with addressing this issue.
NEAT (Nocturnal Enuresis Alarm Therapy) Study
A study of a novel bedwetting alarm.Bed-wetting is a significant problem for many children, negatively impacting their social and emotional health. Ten per cent of school-aged children suffer from bed-wetting and unfortunately only one third of these children and families seek medical help for this debilitating problem. The usual line of treatment is using a bed-wetting alarm to train children to become dry at night, however, up to one third of children who use devices currently on the market do not respond to this treatment. The research team at The Children’s Hospital at Westmead have developed a novel wireless bedwetting alarm which was tested in a clinical trial setting.
The NEAT study commenced in May 2009 and recruited 350 participants with significant bed-wetting to use either the new alarm device or a commercially available alarm. Recruitment has now finished and we found that our new alarm was more effective than the commercial alarm with reduced time for alarm training and more children becoming dry. We are now in the process of writing up the results. The finding were presented at both national & international conferences, winning a prize at the Royal Australasian College of Physicians conference in Brisbane in 2012 and the International Children’s Continence Society conference in London in 2012. We plan to publish the research soon before releasing the product on the market for purchase by parents.
WATCH: Watch with Alarm for Timed-voiding in CHildren
Daytime urinary incontinence (DUI) affects 20% of all school age children, which can impact on their self-esteem and quality of life, leading to associated lower self-esteem, teasing and social problems. Untreated childhood DUI may also result in adult incontinence. Timed voiding is an established treatment for daytime urinary incontinence in adults but is difficult for children. There is uncertainty as to whether an alarm watch will improve compliance with timed voiding in children. The study aims to compare timed voiding using an alarm watch with a non-alarming watch in a randomised controlled trial. Three hundred and sixty children aged between 5 – 13 years will be recruited to this study.
The Children’s Hospital at Westmead commenced enrolling children with DUI for this study in September 2011, funded by the Foundation for Children. This study is currently still recruiting participants, so if you would like more information, please either telephone 0429 468 883 or email the Trial Coordinators Marianne Kerr at or Sana Hamilton
Cochrane Kidney and Transplant
Cochrane Kidney and Transplant, part of the international Cochrane network, is responsible for the publication of systematic reviews in kidney disease and coordinating and maintaining a database of all studies relating to kidney disease, in both adults and children.
The Caring for Australasians with Renal Impairment (KHA-CARI) Guidelines. These guidelines for Nephrologists serve as both a valuable educational resource and a means of enhancing the quality, appropriateness, consistency and cost-effectiveness of kidney health care.
Our laboratory is looking at rejection and tolerance of kidney transplants and the possible causes and treatment of a variety of renal diseases, including those with genetic causes and developing new treatments for atherosclerosis, a major problem in patients with kidney disease.
The Centre also provides infrastructure to young clinical researchers in Australia, developing a national network of kidney disease clinician-scientists, making that goal for a cure just one step closer.