Kidney failure is one of the strongest risk factors for cardiovascular disease and death. As a nephrologist, I aim to reduce cardiovascular risk as much as possible by preventing my patients from reaching end-stage kidney failure and the need kidney replacement therapy (dialysis or transplantation). Good control of hypertension (high blood pressure) is absolutely essential. Once patients, despite preventative efforts, have reached end-stage kidney failure and are on dialysis, our aim is to offer the best therapy and reduce the burden of disease and increase of quality of life as much as possible. 

As a physician-scientist, I focus on clinical research with the aim of improving treatments and patient well-being.

Controlling high blood pressure with renal denervation

In hypertension research, our focus is on studies aimed at improving the quality of blood pressure control. We’re investigating renal denervation (the destruction of pathologically active nerves to and from the kidneys) as treatment for poorly controlled hypertension. To this end, we’ve performed multiple investigator-initiated studies and are a participating center in global trials.

Why is it so difficult to stick to a medication plan?

Additionally, it is increasingly clear that, although taking medication when prescribed may seem common sense, patients often do not, or cannot, stick to a proper medication regime. We need to understand why adherence is so difficult and develop methods to improve it. This subject is a focus of upcoming research. 

A Europe-wide clinical trial to compare two types of dialysis treatments

We are coordinating a new EU consortium called CONVINCE, that runs a randomized Europe-wide clinical trial comparing two types of dialysis treatments, hemodiafiltration and standard dialysis. This trial will enroll 1800 patients in 7-8 countries and 40-60 clinical centers. Hemodiafiltration is not new, but controversy surrounding the benefits of this procedure has delayed broad acceptance as a treatment option. Thus far, only four trials have tested hemodiafiltration and their results were inconclusive. We conducted a meta-analysis of these trials, and our findings suggest that hemodiafiltration is indeed beneficial.

Taking patient perspectives into account during clinical trials

Furthermore, we’re discovering that the key endpoints of a clinical trial that are usually addressed, for example being disease-free, may not be the most important outcome that patients want from an experimental treatment or drug. They may simply want to feel better. Thus, we need to start asking ourselves: is the improvement we made to a therapy indeed also considered valuable by the patients themselves. This means that we need to incorporate patient perspectives as an endpoint. The large European trial aims to deliver definite proof on the question of whether hemodiafiltration is superior to standard hemodialysis regarding effects on cardiovascular disease and death and on various domains of patients’ perspectives.

Our future focus: environmental sustainability of healthcare

Climate change has an effect on human health and vice versa, health care also considerably contributes to greenhouse gas emissions. Within the EU, we’re taking an active role in the environmental sustainability of healthcare. 

Publications at Jan 1st 2018: approximately 300 in peer-reviewed journals