Following a fantastic start to this year’s Congress, we have a busy programme today featuring a range of interesting and insightful presentations, including:

One of today’s ‘must see’ sessions is Plenary Lecture 1 by eminent scientist Professor Catherine Boileau, Chair of the Department of Genetics at University Hospital Bichat, Paris. She teaches Genetics at the Medical School of Paris Diderot University. She previously served on the Governing Board of Paris University Hospitals (Assistance Publique-Hôpitaux de Paris) and the Research Director of the Northern University Hospitals.

Catherine has carried out research for more than 35 years and headed research teams at Inserm. She is one of the scientists who transformed understanding of cholesterol metabolism by identifying the key role of the PCSK9 gene, the fundamental discovery behind the development of the PCSK9 inhibitors.

Today she will discuss the role of human genetics in identifying novel drug targets and speeding the drug development process in her lecture PCSK9: a journey of discovery from genetics to clinical trials. Catherine is the recipient of numerous awards for her ground-breaking work, including the Chevalier de la Légion d’Honneur, the highest French order of merit.

Screening for chronic kidney disease (CKD) has traditionally been limited to patients with known diabetes, hypertension or cardiovascular disease (CVD). Unfortunately, many of these patients are not screened, or are not known yet to their General Practitioner (GP) with these abnormalities. Consequently, subjects with CKD are often detected late, thus allowing only late start of preventive treatment.

Albuminuria defines the early stages of CKD and is the strongest risk factor for CKD progression. It is not yet established whether screening the general population for early-stage CKD is worthwhile. To address this knowledge gap, Ronald Gansevoort and his colleagues from The Netherlands designed the prospective THOMAS Study to investigate participation rate, yield and cost-effectiveness of two different home-based population albuminuria screening strategies.

Participants were randomised to undergo screening either via collection of a urine sample at home in a conventional urine collection device (UCD) that is sent to a laboratory for albumin creatinine ratio (ACR) measurement, or via a more innovative home-based ACR test with a dipstick reading via a smartphone app. People with confirmed albuminuria were invited for screening for CKD and CVD risk factors. When abnormalities including high blood pressure, raised cholesterol, type 2 diabetes, or impaired kidney function were found, participants were referred to their GP for treatment according to current guidelines.

The investigators found that home-based screening for albuminuria in the general population has a high participation rate and that the yield to find unknown CKD and risk factors for progression of CKD and CVD is good. A preliminary analysis also suggests that the cost-effectiveness of such a screening program is acceptable.

“These findings provide a solid evidence base to start a prospective randomised screening trial that includes a control group,” concluded Ronald Gansevoort. “Such a trial should study whether population screening and subsequent treatment has a beneficial effect on the incidence of hard outcomes such as end-stage kidney disease and cardiovascular events.
This will be the last step that is needed before population screening for albuminuria can be implemented in routine clinical practice.”

This afternoon, ERA together with Société Francophone de Néphrologie Dialyse et Transplantation (SFNDT) will be hosting a symposium evaluating ‘Artificial Intelligence in Nephrology’. The session will be chaired by Professor Maryvonne Hourmant, Head of the Nephrology and Clinical Immunology Department in Nantes, France and Jadranka Buturovic-Ponikvar, Medical Director at University Medical Center Ljubljan Slovenia.

During the session, Professor Alexandre Loupy, Head of Inserm Unit at Paris Translational Research Center for Organ Transplantation, will discuss the role of databases in the clinic. Alexandre’s research focuses on artificial intelligence and multi-organ transplantation analytics. In 2020, Alexandre won the Ile-de-France Region Health Innovators Prize for his discoveries in the field of transplantation and transplant rejection and for the deployment of an application based on artificial intelligence.

Professor Vincent Vuiblet, Director of the Institute of Artificial Intelligence (IIAS) in Health will also present at the session. IIAS is a federative research structure in the field of health data sciences that provides expertise in health and data science, health data, and data processing capabilities. Within the IIAS, Vincent determines the strategic axes, defines and develops the human and technical resources of the institution in order to enhance the work carried out.

With more than 940,000 patient records, dating back as far as 1965 in some cases, the ERA Registry is an important resource to make the most of the available nephrology data for research and education.

In the first presentation, Rianne Boenink, Netherlands, will discuss Results of the European transplant survey: initiatives and barriers affecting kidney transplant rates.

Next, Henna Puusaari, Finland, will present information on Mortality due to malignancies in children starting kidney replacement therapy after cancer therapy.

Finally, Esther de Rooij, Netherlands, will share data on The effect of dialysis initiation on health-related quality of life and symptoms in older patients.

With more than 940,000 patient records, dating back as far as 1965 in some cases, the ERA Registry is an important resource to make the most of the available nephrology data for research and education.

Today, the Registry includes more than 940,000 patient records, dating back as far as 1965 for some countries. As it collects data from national and regional renal registries, this can often lead to a time-lag in the publication of European data, as the Registry can only publish once every country has made its submission.

The role of the Registry during the COVID-19 pandemic

Despite the usual delays to publication, in April 2020 — very soon after the start of the pandemic — the Registry was able to work with seven countries to report on early mortality in European KRT patients affected by COVID-19. “We were the first to describe the substantial mortality in this patient group based on population-based data,” Kitty highlighted, “for example that more than 44% of transplant recipients aged 75 years or older died in the first 28 days of their disease.”

Further analyses are planned in the near future on the effects of the pandemic on the incidence and prevalence of KRT, transplant rates and mortality, including data from many more countries.

Plans for the Registry in the year ahead

The Registry is in the process of extending our work in kidney transplant research by setting up new studies and collecting additional data in this area. “Hopefully, at some time in the future, this will lead to structural data collection that will further enable European collaborative transplant research. Similar activities are ongoing for CKD Stage 4-5 patient data.”

The role of the Registry in nephrology education

To date the Registry has organised around fifty introductory courses and pre-congress workshops in epidemiology to educate nephrologists in Europe and beyond. Over the years, these courses have served as a basis for a series of epidemiology papers on both basic and advanced topics, including article series in Kidney International, NDT, Nephron Clinical Practice, Clinical Kidney Journal and Nephrology. An overview of this work is available on the ERA website.

“As well as increasing knowledge of clinical research methods, our courses are intended to facilitate contact and collaboration between European nephrology researchers. We are therefore very happy that they will resume in Krakow (Poland) next month,” Kitty concluded.