ROCKETing change: Aussie nephrologist leads global charge on kidney disease in heart failure trials

To tackle one of medicine’s most dangerous double acts – heart failure and chronic kidney disease – a Sydney nephrologist is launching an international research consortium backed by nearly $500 million dollars from NSW Health.

Led by Royal North Shore Hospital’s Associate Professor Brendon Neuen, the ROCKET Consortium (Renal Outcomes in Cardiac Failure and Kidney Disease Epidemiology and Trials), will unite Australian clinicians with Harvard Medical School, Tufts Medical Centre in Boston, and the University of Groningen in the Netherlands. Together, they aim to transform how kidney disease progression is measured in people with heart failure, a long-standing gap in global clinical trial design.

At the core of the collaboration is a bold ambition to analyse data from 12 major heart failure trials involving more than 50,000 patients, and finally settle on a gold standard for tracking kidney function in heart failure clinical trials.

“Nearly half of people with heart failure are also living with chronic kidney disease which means they generally do worse overall and are admitted to hospital more often,” said Associate Professor Neuen, Director of Kidney Trials at Royal North Shore Hospital and Senior Research Fellow at The Kolling Institute and The George Institute.

“However, without a standard method of measuring loss of kidney function in heart failure trials, we are potentially missing opportunities to identify treatments which could protect the heart and kidneys.”

The NSW Health grant is part of a targeted funding round to accelerate innovation in heart disease. ROCKET is among the most ambitious of the funded projects, with potential ripple effects for drug development and regulatory guidelines worldwide.

“Our research is already drawing attention from the U.S. Food and Drug Administration as it has the potential to inform regulatory standards and the development of new medications for both heart failure treatments and kidney disease,” explained Associate Professor Neuen.

“With a large share of the community living with heart and kidney disease, we are hopeful our work will improve the long-term health and wellbeing of people affected by both conditions.”

Associate Professor Neuen has also led SMART-C, a global consortium pooling all the available clinical trial data for sodium-glucose cotransporter-2 (SGLT2) inhibitors, a drug used for treating type 2 diabetes, heart failure and chronic kidney disease. The consortium includes data on over 90,000 patients enrolled in 13 global clinical trials.

This public-private partnership involves more than 12 institutions including Harvard, Yale, Stanford, Oxford and Sydney Universities, and others in Europe, as well as major pharmaceutical companies.

While the drug class was known to have cardiovascular benefits, Associate Professor Neuen’s work has shown that the SGLT2 inhibitors reduce kidney disease progression, even in people without diabetes, and that the drug class has prominent benefits in preventing heart failure and sudden cardiac death.

“You must be able to lead large groups of people and bring them with you over the course of a trial which can takes several years. The reward is if you can do that, you can make a huge impact on patient care because what changes guidelines and what changes people’s treatments are clinical trials,” stated Associate Professor Neuen.

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