Southampton Academy of Research

Dr Caroline Anderson is a Clinical Academic Paediatric Dietitian at University Hospital Southampton (UHS), and holder of a Research Leaders Programme (RLP) award.

Her research interests focus on the growth, nutrition and wellbeing of babies, children and young people with kidney disease.

She leads the paediatric renal dietetics service for patients with kidney disease at UHS, and is co-lead for paediatric nephrology research and improvement. She is also dissemination lead for the International Paediatric Renal Nutrition Taskforce.

Struggling to grow

The number of children with chronic kidney disease in the UK is rising, and they are needing increasingly complex care. These children struggle to grow, meaning they are often smaller than their friends. This not only affects their physical health, but can also affect their mental health.

“An 18-year-old boy doesn’t want to be the size of a 12-year-old, which can be the reality for a lot of our children,” says Caroline. 

“They can look very thin, or short and thin and in recent years we are seeing more children who are short and overweight or obese That can have a negative psychological impact, and poor mental health is huge in chronic kidney disease.”

Children with kidney disease can feel tired all the time, and often find it hard to attend or concentrate at school. It can make them feel or be sick, change how food tastes and reduce their appetite.

Delaying transplant and dialysis

The condition gets worse over time, but good nutrition and a well-managed diet can help delay the need for dialysis or a kidney transplant.

This often involves ‘dietary modifications’, for example by making sure they don’t eat too many foods high in salt, potassium and phosphorus, or controlling how much they drink.

At the same time, families need to make sure their child is getting everything they need to grow and develop. Ideally this comes from food, but sometimes these children may also need to take special feeds or nutritional supplements. Managing all of this can be very challenging.

“Kidney disease is a lifelong condition with no cure. We know that the burden is huge for families, and it impacts on all aspects of their lives,” explains Caroline.

“My areas of interest are growth and nutrition, and how we can improve the patient experience to get them to live well for as long as they can. The main aim is to delay transplant and dialysis for as long as possible – into adulthood if we can – and nutrition is one of the cornerstones of treatment.”

Answering questions

During her PhD, which she completed in 2013, Caroline investigated the energy balance, nutritional intake, body composition and physical activity of children with chronic kidney disease.

She found a huge variation in children’s nutritional status and growth, even when they were on the same dietary modifications. Now, she’s using her RLP award to try to find out why.

She plans to run a feasibility study to identify markers of ill health, kidney injury and issues with metabolism. This will enable children with kidney disease who are most at risk of problems with their growth to be identified and treated.

To do this, she will be working with a wide range of experts from many different fields. In Southampton, these include Dr Rodney Gilbert, Professor Philip Calder, Prof Jonathan Swan, Prof Martin Feelish and Prof Mike Grocott. She will also work with other experts, such as Prof Bradley Warady at the University of Missouri-Kansas City in the USA.

“I’m hoping that, with this Research Leaders Programme award, I can work with all these experts in their fields to develop a really strong and robust research protocol,” says Caroline.

“We can use this to do as a feasibility study in the first instance, and then go for a larger grant and muti-centre trial to try and answer some of these questions.”

Making a real difference

Caroline intends to use her RLP award to take her research to the next level and advance her career.

She plans to work towards becoming an independent researcher, developing new collaborations with relevant experts, and learning the skills she needs to successfully apply for competitive grants. She also hopes to inspire and support others to become involved in research alongside clinical care.

“I want to take the next step, in terms of being able to make a real difference,” she says.

“I’ve been really lucky, doing my PhD in Southampton and having postdoc support. We’ve done lots of little projects showing how we can improve outcomes with different nutritional interventions, but the Research Leaders Programme will really take me up to the next level.

“It will help me apply for those big research funding pots, so we can do really meaningful muti-centre trials to look at nutritional interventions and why children do or don’t grow.”