Enhancing care for kidney disease

By Emily Leighton, MA'13

Working on a COVID-19 ward at a hospital in Italy’s Lombardy region, Dr. Fabio Salerno found himself at the epicentre of Europe’s coronavirus outbreak.

It was late March. The country’s intensive care units were overwhelmed, ventilators were in short supply and health authorities were imploring retired health care professionals to return to work.

As a PhD Candidate based at Robarts Research Institute and London Health Sciences Centre’s Kidney Clinical Research Unit, Dr. Salerno’s research activities had been temporarily paused as the first wave of the global pandemic reached Ontario. A trained nephrologist, he quickly made the decision to return to his home country to help in whatever way he could.

“My friends at home in Italy were telling me how bad the situation was; it was a national catastrophe,” he said. “I’m a doctor, so I felt there was something I could do to help.”

From March to early July, Dr. Salerno worked at San Gerardo Hospital in Monza, Lombardy. He remembers sleeping in head-to-toe personal protective equipment at times, working extra shifts to address the high volume of patients.

Despite the long hours and uncertainty, he is grateful to have had the opportunity to learn and positively contribute to frontline efforts. “I’ve never experienced the spirit and collaboration with my medical colleagues in the same way before,” he said. “We put aside the usual complaints and competition to work toward a common goal. I found that aspect of the experience to be really beautiful.”

Born and raised in northern Italy, Dr. Salerno completed medical school at the University of Milano-Bicocca. After graduating, he pursued specialty training in nephrology.

A connection between his Italian supervisor and Dr. Chris McIntyre, Professor of Medicine, Medical Biophysics and Paediatrics, resulted in a visiting research placement in London. “It was an opportunity to train with a world-renowned researcher and gain exposure to an international environment,” said Dr. Salerno.

Right away, Dr. McIntyre introduced him to research being led by Robarts scientist Grace Parraga, PhD, focused on using magnetic resonance imaging (MRI) with an inert gas inhaled into the lungs to visualize airway function. He was interested in applying this imaging technique to better understand the connection between kidney disease, dialysis and the lungs.

People with kidney disease frequently develop complications outside the kidneys, including heart disease, one of the most common causes of death. Many patients on dialysis experience shortness of breath, which is a symptom often attributed to heart disease in these patients, but an underlying lung disease may not be taken into account because it is hard to diagnose with standard tests and medical imaging.

“We might be missing lung disease in dialysis patients,” explained Dr. Salerno.

After completing his nephrology training, Dr. Salerno began full-time PhD studies in 2018 to further investigate lung function in hemodialysis patients using magnetic resonance imaging (MRI) and computed tomography (CT). He is co-supervised by Dr. McIntyre and Parraga.

Unfortunately, COVID-19 disrupted this research project significantly, as restrictions put most of the study’s procedures – involving participants performing several breathing tests in a confined space – on hold indefinitely.

Future possibilities include applying preliminary findings from this study to analyze lung CT scans from dialysis patients that were acquired for other studies. But faced with these setbacks, he is re-focusing part of his research on sodium imaging as a potential tool to enhance and personalize dialysis treatments.

Dialysis is a process that removes excess water, solutes and toxins from the blood for people whose kidneys can no longer perform these functions naturally. As part of the process, clinicians calculate a patient’s ‘dry weight’ – their standard weight after dialysis removes the excess waste and fluid.

But calculating dry weight is complicated and can be fairly inaccurate. By imaging the amount of sodium that has accumulated in a patient’s tissues, Dr. Salerno hopes to improve the process.

“Dialysis saves people’s lives, but it can also be harmful,” he said. “If we remove too much fluid too quickly, blood pressure drops, and patients can go into shock. This can be the result of an inaccurate dry weight. If we can see the sodium and quantify it, we can more accurately determine each patient’s dry weight.”

In a year with many unexpected twists, Dr. Salerno is grateful to be selected as one of 10 graduate trainees to receive an inaugural Dean’s Research Scholarship from the Schulich School of Medicine & Dentistry. The Scholarship aims to enhance collaborative and translational research, a topic that resonates strongly with him.

“In Italy, I saw first-hand how the lack of evidence for COVID-19 impacted our ability to treat and care for patients,” he said. “It emphasized for me the value of scientific research; it’s more important than ever before.”