Dr Suetonia Palmer

University of Otago, Christchurch, New Zealand

Dr Suetonia Palmer is challenging the status quo for kidney disease treatment and helping millions of people with chronic kidney disease take back control of their lives.

Working from temporary facilities as Christchurch rebuilds, she is guiding doctors and policy makers across the world as they attempt to make the best decisions for their patients.

Kidneys clean our blood, remove toxins, make vitamins and much more. But more than ten per cent of us will develop kidney disease and enter a lifelong process of disease management.

Suetonia realised that the information available to doctors and patients is often confusing and sometimes wrong.

She’s changing the lives of people with kidney disease by making sure they and their doctors have access to the best information via a series of Cochrane Reviews that take millions of bits of information and turn them into best practice guidelines.

Her 2012 L’Oréal Australia & New Zealand For Women in Science Fellowship will take her work further and help her study what information people receive when their kidney disease worsens and they have to go on dialysis. That usually requires four hours a day, four days a week in hospital. However, in Christchurch most people have dialysis machines at home. Suetonia will determine what is best practice.

“I believe we can do much more to help people with kidney disease feel better, get back to work, and give them control of their own treatment,” she says.

When Suetonia started training as a junior doctor she had the opportunity to work in the kidney unit in Christchurch. There she developed a deep appreciation of the work our kidneys do. “The kidney is a remarkable organ. Apart from the simple tasks of filtering and cleaning blood, it makes all sorts of important compounds such as erythropoietin (EPO), which manages red blood cell production. And they probably perform all sorts of jobs that we haven’t discovered yet,” Suetonia says.

“When our kidneys go wrong, the early signs are usually silent—we get tired, our blood pressure increases, we become anaemic, and we can just feel awful. Unfortunately, when people get kidney disease it’s usually for life. They live with the disease. I realised that my role was to be part of their journey, helping them feel as good as they can be and as informed as they can be.”

Suetonia found working with a patient over months or years was incredibly rewarding. But she also realised that the information available to doctors and patients about kidney disease was confusing and sometimes contradictory. She set out to change that.

Today she spans the gap between research and the clinic as a senior lecturer in the Department of Medicine at the University of Otago in Christchurch

“Working in the clinic I realised that some of the treatments used every day may be less effective than we think they are and that some of the tools we use to track disease progress may not really do the job we need.”

So Suetonia set about reviewing the best practice from around the world and writing it up in a series of Cochrane Reviews on kidney disease.

Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care.

“A Cochrane Review answers the question, ‘How do you know if one treatment will work better than another, or if it will do more harm than good?’” says Suetonia.

Suetonia has become an editor for the Cochrane Renal Group, working with colleagues in Sydney, Brisbane, Italy and Canada. Each review is prepared by an ‘author team’ with support from specialist librarians, methodologists, copy and content editors, and peer reviewers, taking hundreds of hours of work from start to finish.

As a result of their work doctors don’t have to hunt around the internet for the latest trial information. “We’ve compiled all the evidence and present the best options. Doctors around the world can make better decisions using the Cochrane information.”

But the reviews have also confirmed her concerns. She and her colleagues have found for example that:

• kidney drug trials are often flawed because they use indirect measures, such as blood levels of phosphorus, cholesterol, and haemoglobin, that may not accurately indicate if the drug is having an impact on clinical outcomes such as heart disease and death
• relying on these flawed markers may cause harm because of the unexpected adverse consequences of treatment
• many drugs are routinely used in people with advanced kidney disease—including erythropoietins, statins, antiplatelets, vitamin D, and phosphate-lowering drugs—but there’s little evidence that they do any good
• patients rate the information they receive about healthcare as incomplete or inaccurate.

“Given the relative lack of treatments shown to improve health outcomes in people with advanced kidney disease, I believe we need to refocus research on the patient experiences of living with kidney disease and rethink our approach to the methods we use to test new healthcare interventions,” she says. And that will be the focus of her L’Oréal Fellowship.

Suetonia and her colleagues are now focussing on gaps in the literature where there is little information on best practice. This includes comparing home versus hospital dialysis, and patient experiences of healthcare, oral disease, depression, and sexual dysfunction. They are also working to better understand the needs and expectations of patients when they learn that they have kidney disease or need dialysis or kidney transplantation.

The Christchurch earthquakes have been an additional complication for her work. “It has affected us all—our patients on dialysis had to leave town because of the lack of reliable water and power, the medical school’s main building has been closed for repair, and our dialysis centre will have to be taken down,”she says.

But she’s not leaving town herself. “Christchurch has a rich research community with strong collaborations. It’s a friendly collegial place to do good work.”

2010 PhD (Medicine), University of Otago, Christchurch, New Zealand

1995 Bachelor of Medicine and Bachelor of Surgery, University of Otago, Christchurch, New Zealand

2011-present Senior Lecturer, Department of Medicine, University of Otago, Christchurch, New Zealand

2012 Best poster, 49th ERA-EDTA Congress, Paris, France, European Renal Association-European Dialysis and Transplant Association

2011 Health Research Council of New Zealand Program Grant extension (years 4-6), “Neurohormonal and genetic prediction and protection in heart disease”

2009‐2010 Postdoctoral Fellowship, Renal Division, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA

2009 & 2010 Don and Lorraine Jacquot Fellowship, Royal Australasian College of Physicians

2008 Best Presentation, Annual Scientific Presentations, Health Research Society of Canterbury, New Zealand

2008 Travelling Scholarship to American Society of Nephrology Renal Week, Philadelphia, USA, Australia and New Zealand Society of Nephrology

2007-2008 National Heart Foundation of New Zealand grant, “Regional secretion and clearance of novel peptides in health and heart disease”

2006‐2008 PhD candidate and Health Research Council of New Zealand Clinical Research Training Fellow, Department of Medicine, University of Otago, Christchurch, New Zealand

2006-2008 Canterbury Medical Research Foundation grant, “Renal impairment in decompensated heart failure”, awarded to Richards M., Palmer, S., Endre, Z., Yandle, T.

2006-2008 National Heart Foundation of New Zealand grant, “Renal impairment in decompensated heart failure”

2006 Jacquot Research Entry Scholarship, Royal Australasian College of Physicians [declined]

2006 Clinical Research Training Fellowship, Health Research Council of New Zealand

2005 Fellow, Royal Australasian College of Physicians

2004 Bruce Morrison Prize for best presentation, Annual Scientific Meeting, New Zealand Nephrology Group

2003 Dr Jack Kilpatrick Memorial Prize for Best Clinical Presentation at Medical Staff Rounds, University of Otago, Christchurch, New Zealand

2001‐2005 Royal Australasian College of Physicians Advanced Training Fellow, Departments of Nephrology at Christchurch and Dunedin Hospitals, New Zealand

1999‐2000 Royal Australasian College of Physicians Basic Training Fellow, Departments of Medicine, Christchurch and Dunedin Hospitals, New Zealand

1998 Senior House Officer, Accident and Emergency Department, Dryburn District General Hospital, Durham, United Kingdom

Palmer S.C., Hayen A., Macaskill P., Pellegrini F., Craig J.C., Elder G.J., Strippoli G.F.M. (2011) Serum levels of phosphorus, parathyroid hormone, and calcium and risks of cardiovascular death and cardiovascular disease in individuals with chronic kidney disease: A systematic review and meta-analysis, Journal of the American Medical Association 305(11):1119-1127. (Impact factor 30.0, 22 citations)

Palmer S.C., McGregor D.O., Macaskill P., Craig J.C., Elder G.J., Strippoli G.F. (2007) Meta-analysis: Vitamin D compounds in chronic kidney disease, Annals of Internal Medicine 147(12):840-53. (Impact factor 16.7, 96 citations)

Palmer S.C., Navaneethan S.D., Craig J.C., Johnson D.W., Tonelli M., Garg A., Pellegrini F., Ravani P., Jardine M., Perkovic V., Graziano G., McGee R., Nicolucci A., Tognoni G., Strippoli G.F.M. (2010) Meta-analysis: Erythropoiesis-stimulating agents in people with chronic kidney disease, Annals of Internal Medicine 153(1):23-33. (Impact factor 16.7, 29 citations)

Palmer S.C., Di Micco L., Razavian M., Craig J.C., Perkovic V., Pellegrini F., Copetti M., Graziano G., Tognoni G., Jardine M., Webster A., Nicolucci A., Zoungas S., Strippoli G.F. (2012) Effects of antiplatelet therapy on mortality and cardiovascular and bleeding outcomes in persons with chronic kidney disease: A systematic review and meta-analysis, Annals of Internal Medicine 156(6):445-59. (Impact factor 16.7, 0 citations)

Palmer S.C., Yandle T.G., Frampton C.M., Troughton R.W., Nicholls M.G., Richards A.M. (2009) Renal and cardiac function for long term (10-year) risk stratification after myocardial infarction, European Heart Journal 30(12):1486-94. (Impact factor 9.8, 2 citations)

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