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Former royal physician talks of dangerous interplay between heart and kidneys

A former physician to Her Majesty The Queen highlighted the damaging links between heart and kidney disease during a talk at the Royal Society of Medicine this week. 

Professor Sir John Cunningham, delivering the 2022 Jephcott Lecture at the historic institution, showed how patient outcomes worsen because of “two-way traffic” between the two organs. He said: “If things go wrong for one, there is a major knock-on effect for the other.” 

He spoke about the case of Jonah Lomu, the New Zealand All Blacks rugby star, who died of a heart attack, aged 40, as a result of complications arising from the kidney disease he had suffered from most of his adult life. 

The dangers of kidney disease are not widely appreciated, Professor Cunningham said. Advanced kidney disease is more deadly than most cancers and is expected to be the fifth leading cause of death in the world by 2040. He added that this is due to the increase in obesity and diabetes in the developed world and decreasing incidence of infectious disease and malnutrition in developing countries. Most deaths caused by chronic kidney disease are cardiac – highlighting the interconnectedness and dangerous interplay between the two organs when things start to go wrong. 

He spoke of advances in treatment and, in particular, highlighted the advances made in the past two decades to break down silos between different branches of medicine, welcoming the “major coming together” of renal and cardiac specialties in recent years. 

Professor Cunningham ended the lecture with a renewed endorsement of early kidney transplant as the best and cheapest option in most cases. Whereas dialysis is the most expensive and least effective option - a dialysis patient aged 25-34 has the lifespan of a healthy 85-year-old – kidney transplantation “transforms the scenario”, he said. 

Following his talk, he fielded questions from the audience on issues such as the future for organ transplantation, the success of new drugs, such as SGLT2 inhibitors, causes and impacts of vascular calcification, and challenges in diagnosing chronic kidney disease. 

Professor Sir John Cunningham is a Professor of Nephrology at University College London Medical School and The Royal Free Hospital and an Honorary Fellow at Trinity Hall, Cambridge. He was Physician to The Queen and Head of the Medical Household from 2005-2014 and was knighted for services to The Queen in 2014. 

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