EMPA-KIDNEY (The Study of Heart and Kidney Protection With Empagliflozin)

Phase 3

Completed

Conditions: Chronic Kidney Disease

Interventions: Drug: Empagliflozin
Drug: Matching placebo

Registration Number: NCT03594110

Lead Sponsor: Boehringer Ingelheim

Brief Summary: The primary aim of the study is to investigate the effect of empagliflozin on kidney disease progression or cardiovascular death versus placebo on top of standard of care in patients with pre-existing chronic kidney disease. After completion of the interventional part of the study (primary study completion) a subset of participants will be followed up in a post-trial observational (non-interventional) manner for cardio-renal outcomes (estimated study completion date).

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 6609

Inclusion Criteria

Age ≥18 years or at "full age" as required by local regulation
Evidence of chronic kidney disease at risk of kidney disease progression defined by at least 3 months before and at the time of Screening Visit
- CKD-EPI eGFR ≥20 to <45 mL/min/1.73m² or
- CKD-EPI eGFR ≥45 to <90 mL/min/1.73m² with urinary albumin:creatinine ratio ≥200 mg/g (or protein:creatinine ratio ≥300 mg/g);
Clinically appropriate doses of single agent RAS-inhibition with either ACEi or ARB unless such treatment is either not tolerated or not indicated
A local Investigator judges that the participant neither requires empagliflozin (or any other SGLT-2 or SGLT-1/2 inhibitor), nor that such treatment is inappropriate;

Key

Exclusion Criteria

Currently receiving SGLT-2 or SGLT-1/2 inhibitor
Diabetes mellitus type 2 and prior atherosclerotic cardiovascular diseasee with an eGFR >60 mL/min/1.73m2 at Screening
Receiving combined ACEi and ARBf treatment
Maintenance dialysis, functioning kidney transplant, or scheduled living donor transplant
Polycystic kidney disease
Previous or scheduled bariatric surgery
Ketoacidosis in the past 5 years
Symptomatic hypotensiond, or systolic blood pressure <90 or >180 mmHg at Screening
ALT or AST >3x ULN at Screening
Hypersensitivity to empagliflozin or other SGLT-2 inhibitor
Any intravenous immunosuppression therapy in last 3 months; or anyone currently on >45 mg prednisolone (or equivalent)
Use of an investigational medicinal product in the 30 days prior to Screening visit
Known to be poorly compliant with clinic visits or prescribed medication
Medical history that might limit the individual's ability to take trial treatments for the duration of the study (e.g. severe respiratory disease; history of cancer or evidence of spread within last 4 years, other than non-melanoma skin cancer; or recent history of alcohol or substance misuse)
Current pregnancy, lactation or women of childbearing potential (WOCBP), unless using highly-effective contraception
Type 1 diabetes mellitus

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Empagliflozin 10 mg	Empagliflozin	Patients with evidence of chronic kidney disease (CKD) at risk of kidney disease progression, with or without diagnosed diabetes mellitus administered orally once daily 10 milligram (mg) film-coated tablets of empagliflozin.
Placebo	Matching placebo	Patients with evidence of chronic kidney disease (CKD) at risk of kidney disease progression, with or without diagnosed diabetes mellitus administered orally once daily film-coated tablets of placebo to match empagliflozin.

Primary Outcome Measures

Name	Time	Method
Interventional Part: Time to First Occurrence of Kidney Disease Progression or Cardiovascular Death ('as Adjudicated')	Follow-up period: From the day of randomisation to the day of the final follow-up visit, up to 1136 days.	Incidence rate of first occurrence of kidney disease progression (KDP) or adjudicated cardiovascular death is reported in the Outcome Measure Data Table. Metrics such as the median time-to-event (TTE) was not estimable due to insufficient events being experienced. Incidence rate= (Number of patients who experienced the event of first occurrence of KDP or cardiovascular death)\100/(patient years at risk (pt-yrs at risk). pt-yrs at risk= sum of time at risk \[days\] over all patients in a treatment group / 365.25. Kidney disease progression was defined as: end stage kidney disease (defined as the initiation of maintenance dialysis or receipt of a kidney transplant) OR * a sustained decline in estimated glomerular filtration rate (eGFR) to \<10 mL/min/1.73m\^2 OR * renal death OR * a sustained decline of ≥40% in eGFR from randomisation.

Secondary Outcome Measures

Name	Time	Method
Interventional Part: Time to First Occurrence of Kidney Disease Progression	Follow-up period: From the day of randomisation to the day of the final follow-up visit, up to 1136 days.	Incidence rate of first occurrence of kidney disease progression is reported in the Outcome Measure Data Table. Metrics such as the median time-to-event (TTE) not estimable due to insufficient events being experienced. Incidence rate of first occurrence of kidney disease progression= (Number of patients who experienced the event of first occurrence of kidney disease progression) \100/(patient years at risk (pt-yrs at risk)). pt-yrs at risk= sum of time at risk \[days\] over all patients in a treatment group / 365.25. Kidney disease progression was defined as: end stage kidney disease (defined as the initiation of maintenance dialysis or receipt of a kidney transplant) OR * a sustained decline in estimated glomerular filtration rate (eGFR) to \<10 mL/min/1.73m\^2 OR * renal death OR * a sustained decline of ≥40% in eGFR from randomisation).
Interventional Part: Time to First Occurrence Cardiovascular Death ('as Adjudicated') or End Stage Kidney Disease (ESKD)	Follow-up period: From the day of randomisation to the day of the final follow-up visit, up to 1140 days.	Incidence rate of first occurrence of cardiovascular death or end stage kidney disease (ESKD) is reported in the Outcome Measure Data Table. Metrics such as the median time-to-event (TTE) not estimable due to insufficient events being experienced. Incidence rate of first occurrence cardiovascular death or end stage kidney disease (ESKD)= (Number of patients who experienced the event of first occurrence of cardiovascular death or end stage kidney disease (ESKD)) \*100/(patient years at risk (pt-yrs at risk)). pt-yrs at risk= sum of time at risk \[days\] over all patients in a treatment group / 365.25. ESKD was defined as the initiation of maintenance dialysis or receipt of a kidney transplant.
Interventional Part: Time to Cardiovascular Death ('as Adjudicated')	Follow-up period: From the day of randomisation to the day of the final follow-up visit, up to 1140 days.	Incidence rate of first occurrence of kidney disease progression is reported in the Outcome Measure Data Table. Metrics such as the median time-to-event (TTE) not estimable due to insufficient events being experienced. Incidence rate of cardiovascular death is reported in the Outcome Measure Data Table. Metrics such as the median time-to-event (TTE) not estimable due to too few events being experienced. Incidence rate of cardiovascular death= (Number of patients who experienced the event of cardiovascular death) \*100/(patient years at risk (pt-yrs at risk)). pt-yrs at risk= sum of time at risk \[days\] over all patients in a treatment group / 365.25.
Key Secondary Endpoint: Interventional Part - Time to First Hospitalization for Heart Failure ('as Adjudicated') or Cardiovascular Death ('as Adjudicated')	Follow-up period: From the day of randomisation to the day of the final follow-up visit, up to 1140 days.	Incidence rate of first hospitalization for heart failure or cardiovascular death is reported in the Outcome Measure Data Table because metrics such as the median time-to-event (TTE) not estimable due to insufficient events being experienced. Incidence rate= (Number of patients who experienced the event of first hospitalization for heart failure or cardiovascular death) \*100/(patient years at risk (pt-yrs at risk)). pt-yrs at risk= sum of time at risk \[days\] over all patients in a treatment group / 365.25.
Key Secondary Endpoint: Interventional Part - Time to Death From Any Cause ('as Adjudicated')	Follow-up period: From the day of randomisation to the day of the final follow-up visit, up to 1140 days.	Incidence rate of death from any cause is reported in the Outcome Measure Data Table. Metrics such as the median time-to-event (TTE) not estimable due to insufficient events being experienced. Incidence rate of death from any cause = (Number of patients who experienced the event of death from any cause) \* 100/(patient years at risk (pt-yrs at risk)). pt-yrs at risk= sum of time at risk \[days\] over all patients in a treatment group / 365.25.
Key Secondary Endpoint: Interventional Part - Time to Occurrences of All-cause Hospitalizations (First and Recurrent Combined)	Follow-up period: From the day of randomisation to the day of the final follow-up visit, up to 1140 days.	Total number of all-cause hospitalizations (first and recurrent combined) is reported in the Outcome Measure Data Table. Conventional time-to-event (TTE) metrics such as the median not calculable for a recurrent TTE analysis.

Trial Locations

Locations (237): University of Malaya Medical Centre
🇲🇾
Kuala Lumpur, Malaysia
CHUS Hopital Fleurimont
🇨🇦
Sherbrooke, Quebec, Canada
CHU de Quebec-Universite Laval Research Centre
🇨🇦
Quebec, Canada
Hospital Sultanah Aminah
🇲🇾
Johor Bahru, Malaysia
Hospital Kajang
🇲🇾
Kajang, Selangor, Malaysia
Hospital Serdang
🇲🇾
Kajang, Selangor, Malaysia
Nephrology Consultants, LLC
🇺🇸
Huntsville, Alabama, United States
Southern California Permanente Medical Group
🇺🇸
San Diego, California, United States
Northwestern University
🇺🇸
Chicago, Illinois, United States
Aventiv Research, Inc
🇺🇸
Mesa, Arizona, United States
East Coast Clinical Research, Inc
🇺🇸
Lake City, Florida, United States
University of California Los Angeles
🇺🇸
Torrance, California, United States
Yale University School of Medicine
🇺🇸
New Haven, Connecticut, United States
Chase Medical Research, LLC
🇺🇸
Thomaston, Connecticut, United States
Midland Florida Clinical Reearch Center, LLC
🇺🇸
DeLand, Florida, United States
University of Florida
🇺🇸
Gainesville, Florida, United States
East Coast Institute for Research, LLC
🇺🇸
Jacksonville, Florida, United States
Total Research Group, LLC
🇺🇸
Miami, Florida, United States
Hanson Clinical Research Center, Inc.
🇺🇸
Port Charlotte, Florida, United States
Emory University
🇺🇸
Atlanta, Georgia, United States
The Jones Center for Diabetes and Endocrine Wellness
🇺🇸
Macon, Georgia, United States
Cedar Crosse Research Center
🇺🇸
Chicago, Illinois, United States
University of Kansas Medical Center
🇺🇸
Kansas City, Kansas, United States
Saint Elizabeth Healthcare
🇺🇸
Covington, Kentucky, United States
Clinical Research Consultants, LLC
🇺🇸
Kansas City, Missouri, United States
SUNY Downstate Medical Center
🇺🇸
Brooklyn, New York, United States
Lexington VA Health Care System - Troy Bowling Campus
🇺🇸
Lexington, Kentucky, United States
Medstar Health Research Institute
🇺🇸
Baltimore, Maryland, United States
Kidney Care and Transplant Services of New England, PC
🇺🇸
West Springfield, Massachusetts, United States
Saint Clair Specialty Physicians
🇺🇸
Roseville, Michigan, United States
VA Southern Nevada Healthcare System
🇺🇸
North Las Vegas, Nevada, United States
Seacoast Kidney and Hypertension Specialists
🇺🇸
Portsmouth, New Hampshire, United States
The University of North Carolina at Chapel Hill
🇺🇸
Chapel Hill, North Carolina, United States
Mountain Kidney and Hypertension Associates, PA
🇺🇸
Asheville, North Carolina, United States
Wake Forest University Health Sciences
🇺🇸
Winston-Salem, North Carolina, United States
Cleveland Clinic
🇺🇸
Cleveland, Ohio, United States
Brookview Hills Research Associates LLC
🇺🇸
Winston-Salem, North Carolina, United States
Carolina Diabetes & Kidney Center
🇺🇸
Sumter, South Carolina, United States
University Hospitals of Cleveland
🇺🇸
Cleveland, Ohio, United States
Thomas Jefferson University
🇺🇸
Philadelphia, Pennsylvania, United States
Regional Health Clinical Research
🇺🇸
Rapid City, South Dakota, United States
Research Institute of Dallas
🇺🇸
Dallas, Texas, United States
Renal Disease Research Institute
🇺🇸
Dallas, Texas, United States
Academy Of Diabetes, Thyroid And Endocrine, PA
🇺🇸
El Paso, Texas, United States
Pioneer Research Solutions, Inc.
🇺🇸
Houston, Texas, United States
P&I Clinical Research, LLC
🇺🇸
Lufkin, Texas, United States
Texas Institute for Kidney and Endocrine Disorders
🇺🇸
Lufkin, Texas, United States
Clinical Advancement Center PLLC
🇺🇸
San Antonio, Texas, United States
University of Texas Health Science Center at San Antonio
🇺🇸
San Antonio, Texas, United States
University of Utah Health Sciences Center
🇺🇸
Salt Lake City, Utah, United States
Salem VA Medical Center
🇺🇸
Salem, Virginia, United States
Providence Medical Research Center
🇺🇸
Spokane, Washington, United States
Kelowna General Hospital
🇨🇦
Kelowna, British Columbia, Canada
St. Paul's Hospital
🇨🇦
Vancouver, British Columbia, Canada
Kidney Care Centre - Surrey
🇨🇦
Surrey, British Columbia, Canada
LMC Endocrinology Centres (Etobicoke) Ltd.
🇨🇦
Etobicoke, Ontario, Canada
London Health Science Centre, University Campus
🇨🇦
London, Ontario, Canada
LMC Clinical Research Inc. (Ottawa)
🇨🇦
Nepean, Ontario, Canada
Vancouver General Hospital
🇨🇦
Vancouver, British Columbia, Canada
LMC Clinical Research Inc. (Bayview)
🇨🇦
Toronto, Ontario, Canada
LMC Clinical Research Inc. (Brampton)
🇨🇦
Brampton, Ontario, Canada
Cambridge Cardiac Care Centre
🇨🇦
Cambridge, Ontario, Canada
LMC Clinical Research Inc. (Thornhill)
🇨🇦
Concord, Ontario, Canada
Lakeridge Health Oshawa
🇨🇦
Oshawa, Ontario, Canada
Toronto General Hospital
🇨🇦
Toronto, Ontario, Canada
Clinical Research Solutions Inc.
🇨🇦
Waterloo, Ontario, Canada
Fadia El Boreky Medicine Professional
🇨🇦
Waterloo, Ontario, Canada
Montreal Clinical Research Institute (IRCM)
🇨🇦
Montreal, Quebec, Canada
Hôpital du Sacré-Coeur de Montréal
🇨🇦
Montreal, Quebec, Canada
IUCPQ (Laval University)
🇨🇦
Quebec, Canada
Beijing AnZhen Hospital
🇨🇳
Beijing, China
Cardiovascular Institute and Fu Wai Hospital
🇨🇳
Beijing, China
Xiangya Hospital, Central South University
🇨🇳
Changsha, China
Xinqiao Hospital
🇨🇳
Chongqing, China
Jinzhou Central Hospital
🇨🇳
Jinzhou, China
The Second Affiliated Hospital Zhejiang University School of Medicine
🇨🇳
Hangzhou, China
Jinling Hospital
🇨🇳
Nanjing, China
Shanghai Fifth People's Hospital affiliated to Fudan University
🇨🇳
Shanghai, China
Shenzhen People's Hospital
🇨🇳
Shenzhen, China
Huazhong University of Science and Technology Union Shenzhen Hospital
🇨🇳
Shenzhen, China
People's Hospital of Sichuan Province
🇨🇳
Sichuan, China
SuZhou Kowloon Hospital
🇨🇳
Suzhou, China
Wuhan Fourth Hospital
🇨🇳
Wuhan, China
The Central Hospital of Wuhan
🇨🇳
Wuhan, China
Zhuzhou Central Hospital
🇨🇳
Zhuzhou, China
Studienzentrum Aschaffenburg
🇩🇪
Aschaffenburg, Germany
Henan Provincial People's Hospital
🇨🇳
Zhengzhou, China
Universitätsklinikum Augsburg
🇩🇪
Augsburg, Germany
Klinikum Bielefeld gGmbH
🇩🇪
Bielefeld, Germany
Städtisches Klinikum Braunschweig gGmbH
🇩🇪
Braunschweig, Germany
Universitätsklinikum Düsseldorf
🇩🇪
Düsseldorf, Germany
ClinPhenomics GmbH & Co KG, Frankfurt
🇩🇪
Frankfurt, Germany
Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen
🇩🇪
Bad Oeynhausen, Germany
Vivantes Netzwerk für Gesundheit GmbH
🇩🇪
Berlin, Germany
Ärztezentrum Helle Mitte
🇩🇪
Berlin, Germany
Universitätsklinikum Carl Gustav Carus Dresden
🇩🇪
Dresden, Germany
Agaplesion Markus Krankenhaus
🇩🇪
Frankfurt, Germany
Nierenzentrum Freiburg
🇩🇪
Freiburg, Germany
Nephrologisches Zentrum Göttingen
🇩🇪
Göttingen, Germany
Universitätsklinikum Halle/S.
🇩🇪
Halle, Germany
Zentrum für Nieren-, Hochdruck und Stoffwechselerkrankungen
🇩🇪
Hannover, Germany
Dialysezentrum Heilbronn ÜBAG für Nephrologie und Dialyse
🇩🇪
Heilbronn, Germany
Medizinische Hochschule Hannover
🇩🇪
Hannover, Germany
Nephrologisches Zentrum Hoyerswerda
🇩🇪
Hoyerswerda, Germany
Universitätsklinikum Jena
🇩🇪
Jena, Germany
Städt. Klinikum, Karlsruhe, Moltkestr.
🇩🇪
Karlsruhe, Germany
Klinikum St. Georg gGmbH
🇩🇪
Leipzig, Germany
Universitätsmedizin der Johannes Gutenberg-Universität Mainz
🇩🇪
Mainz, Germany
Universitätsklinikum Mannheim GmbH
🇩🇪
Mannheim, Germany
Nephrologisches Zentrum Mettmann
🇩🇪
Mettmann, Germany
Dialysezentrum Neckarsulm
🇩🇪
Neckarsulm, Germany
Nephrologisches Zentrum Velbert
🇩🇪
Velbert, Germany
Klinikum der Universität München - Campus Innenstadt
🇩🇪
München, Germany
KfH Kuratorium für Dialyse und Nierentransplantation e.V.
🇩🇪
Nürnberg, Germany
MVZ Diaverum Potsdam
🇩🇪
Potsdam, Germany
MVZ DaVita Viersen GmbH
🇩🇪
Viersen, Germany
Universitätsklinikum Regensburg
🇩🇪
Regensburg, Germany
Universitätsklinikum Ulm
🇩🇪
Ulm, Germany
Robert-Bosch-Krankenhaus GmbH
🇩🇪
Stuttgart, Germany
Nephrologisches Zentrum Villingen-Schwenningen
🇩🇪
Villingen-Schwenningen, Germany
Gemeinschaftspraxis für Nephrologie und Rheumatologie
🇩🇪
Wiesbaden, Germany
Universitätsklinikum Würzburg AÖR
🇩🇪
Würzburg, Germany
Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo
🇮🇹
Alessandria, Italy
A.O. Policlinico Giovanni XXIII di Bari
🇮🇹
Bari, Italy
A. O. Ospedale Civile di Vimercate e Circolo di Desio
🇮🇹
Desio, Italy
Policlinico S. Orsola Malpighi
🇮🇹
Bologna, Italy
ASST degli Spedali Civili di Brescia
🇮🇹
Brescia, Italy
Azienda Ospedaliera Universitaria di Padova
🇮🇹
Padova, Italy
Osp. S. Giovanni di Dio
🇮🇹
Firenze, Italy
Ospedale S. Cuore di Gesù
🇮🇹
Gallipoli, Italy
Azienda Ospedaliera San Martino
🇮🇹
Genova, Italy
Ospedale della Versilia
🇮🇹
LIDO DI Camaiore (LU), Italy
Ospedale Martini
🇮🇹
Torino, Italy
A.O.U.Policlinico G.Martino
🇮🇹
Messina, Italy
Milano Fondazione IRCCS Ca'Granda-Ospedale Maggiore Policlinico
🇮🇹
Milano, Italy
IRCCS San Raffaele
🇮🇹
Milano, Italy
AOU Università degli Studi della Campania Luigi Vanvitelli
🇮🇹
Napoli, Italy
A.O. Univ. Policlinico "Paolo Giaccone"
🇮🇹
Palermo, Italy
Poli Univ A. Gemelli
🇮🇹
Roma, Italy
Azienda Ospedaliera Sant'Andrea-Università di Roma La Sapienza
🇮🇹
Roma, Italy
Ospedale Ignazio Veris delli Ponti
🇮🇹
Scorrano (LE), Italy
IRCCS Ospedale "Casa Sollievo della Sofferenza"
🇮🇹
SAN Giovanni Rotondo (FG), Italy
A.O. Univ. Integrata di Verona
🇮🇹
Verona, Italy
Chubu Rosai Hospital
🇯🇵
Aichi, Nagoya, Japan
Aichi Medical University Hospital
🇯🇵
Aichi, Japan
Fukui Prefectural Hospital
🇯🇵
Fukui City, Japan
Joumou Ohashi Clinic
🇯🇵
Gumma, Maebashi, Japan
Fukuoka University Hospital
🇯🇵
Fukuoka, Fukuoka, Japan
Maebashi Hirosegawa Clinic
🇯🇵
Gunma, Japan
Ota Diabetes Clinic
🇯🇵
Gunma, Japan
Koukan Clinic
🇯🇵
Kawasaki, Japan
University of Tsukuba Hospital
🇯🇵
Ibaraki, Tsukuba, Japan
Medical Corporation Seijinkai Ikeda Hospital
🇯🇵
Kagoshima, Japan
Tokai University Hospital
🇯🇵
Kanagawa, Japan
Kobe University Hospital
🇯🇵
Kobe, Japan
Nagoya University Hospital
🇯🇵
Nagoya, Japan
Tohoku University Hospital
🇯🇵
Miyagi, Sendai, Japan
Kawasaki Medical School Hospital
🇯🇵
Okayama, Kurashiki, Japan
Okayama University Hospital
🇯🇵
Okayama, Okayama, Japan
AMC Nishi-umeda Clinic
🇯🇵
Osaka, Japan
Kansai Electric Power Hospital
🇯🇵
Osaka, Japan
Iwasaki Internal Medicine Clinic
🇯🇵
Osaka, Japan
Shin Clinic
🇯🇵
Tokyo, Ota-ku, Japan
Shiga University of Medical Science Hospital
🇯🇵
Shiga, Otsu, Japan
University Kebangsaan Malaysia
🇲🇾
Cheras, Kuala Lumpur, Malaysia
Juntendo University Hospital
🇯🇵
Tokyo, Bunkyo-ku, Japan
The University of Tokyo Hospital
🇯🇵
Tokyo, Bunkyo-ku, Japan
Center Hospital of the National Center for Global Health and Medicine
🇯🇵
Tokyo, Shinjuku-ku, Japan
Tokyo-Eki Center-building Clinic
🇯🇵
Tokyo, Japan
Hospital Sultanah Bahiyah
🇲🇾
Alor Setar, Kedah, Malaysia
Hospital Kuala Lumpur
🇲🇾
Kuala Lumpur, Malaysia
Hospital Ampang
🇲🇾
Ampang, Malaysia
Hospital Pulau Pinang
🇲🇾
Georgetown, Pulau Pinang, Malaysia
Hospital Raja Permaisuri Bainun
🇲🇾
Ipoh, Perak, Malaysia
Hospital Sultanah Nur Zahirah
🇲🇾
Kuala Trengganu, Malaysia
Hospital Tengku Ampuan Afzan
🇲🇾
Kuantan, Malaysia
Sarawak General Hospital
🇲🇾
Kuching, Sarawak, Malaysia
Hospital Kulim
🇲🇾
Kulim, Kedah, Malaysia
Hospital Melaka
🇲🇾
Melaka, Malaysia
Hospital Pakar Sultanah Fatimah
🇲🇾
Muar, Malaysia
Hospital Selayang
🇲🇾
Selangor, Malaysia
Hospital Tuanku Ja'afar
🇲🇾
Seremban, Negeri Sembilan, Malaysia
Pusat Perubatan UiTM Jalan Hospital
🇲🇾
Sungai Buloh, Malaysia
Hospital Sultan Abdul Halim
🇲🇾
Sungai Petani, Malaysia
Belfast City Hospital
🇬🇧
Belfast, United Kingdom
Royal Sussex County Hospital
🇬🇧
Brighton, United Kingdom
University Hospital of Wales
🇬🇧
Cardiff, United Kingdom
University Hospital Coventry
🇬🇧
Coventry, United Kingdom
Royal Devon and Exeter Hospital
🇬🇧
Exeter, United Kingdom
Hull Royal Infirmary
🇬🇧
Hull, United Kingdom
Royal Free Hospital
🇬🇧
London, United Kingdom
Hospital Taiping
🇲🇾
Taiping, Perak, Malaysia
Oakenhurst Medical Practice
🇬🇧
Blackburn, United Kingdom
University Hospitals of Leicester
🇬🇧
Leicester, United Kingdom
The Royal London Hospital
🇬🇧
London, United Kingdom
Hammersmith Hospital
🇬🇧
London, United Kingdom
Freeman Hospital
🇬🇧
Newcastle, United Kingdom
Norfolk and Norwich University Hospital
🇬🇧
Norwich, United Kingdom
Wessex Kidney Centre
🇬🇧
Portsmouth, United Kingdom
Salford Royal Hospital
🇬🇧
Salford, United Kingdom
Northern General Hospital
🇬🇧
Sheffield, United Kingdom
University Hospitals of North Midlands
🇬🇧
Stoke-on-Trent, United Kingdom
Antrim Area Hospital
🇬🇧
Antrim, United Kingdom
Hathaway Medical Centre
🇬🇧
Chippenham, United Kingdom
Ninewells Hospital & Medical School
🇬🇧
Dundee, United Kingdom
Queen Elizabeth University Hospital
🇬🇧
Glasgow, United Kingdom
Gloucestershire Royal Hospital
🇬🇧
Gloucester, United Kingdom
Aintree University Hospital
🇬🇧
Liverpool, United Kingdom
St George's Hospital
🇬🇧
London, United Kingdom
Nottingham City Hospital
🇬🇧
Nottingham, United Kingdom
Ulster Hospital
🇬🇧
Belfast, United Kingdom
Queen Elizabeth Hospital
🇬🇧
King's Lynn, United Kingdom
Kent & Canterbury Hospital, Oncology Department, Canterbury
🇬🇧
Canterbury, United Kingdom
St Helier Hospital
🇬🇧
Carshalton, United Kingdom
Southmead Hospital
🇬🇧
Bristol, United Kingdom
West Suffolk Hospital
🇬🇧
Bury St Edmunds, United Kingdom
Darent Valley Hospital, Chemotherapy Unit
🇬🇧
Dartford, United Kingdom
Royal Derby Hospital
🇬🇧
Derby, United Kingdom
Cheltenham General Hospital
🇬🇧
Cheltenham, United Kingdom
Dorset County Hospital
🇬🇧
Dorchester, United Kingdom
Royal Infirmary of Edinburgh
🇬🇧
Edinburgh, United Kingdom
Ipswich Hospital
🇬🇧
Ipswich, United Kingdom
St James's University Hospital
🇬🇧
Leeds, United Kingdom
Altnagelvin Area Hospital
🇬🇧
Londonderry, United Kingdom
North Middlesex Hospital
🇬🇧
London, United Kingdom
King's College Hospital
🇬🇧
London, United Kingdom
Daisy Hill Hospital
🇬🇧
Newry, United Kingdom
Churchill Hospital
🇬🇧
Oxford, United Kingdom
St Bartholomew's Medical Centre (OxFed)
🇬🇧
Oxford, United Kingdom
Derriford Hospital
🇬🇧
Plymouth, United Kingdom
Royal Berkshire Hospital
🇬🇧
Reading, United Kingdom
Queen's Hospital
🇬🇧
Romford, United Kingdom
Lister Hospital
🇬🇧
Stevenage, United Kingdom
Great Western Hospital
🇬🇧
Swindon, United Kingdom
Royal Cornwall Hospital
🇬🇧
Truro, United Kingdom
Walsall Manor Hospital
🇬🇧
Walsall, United Kingdom
Princess Royal Hospital
🇬🇧
Telford, United Kingdom