The latest EURECA-m paper ‘Intravenous iron therapy and the cardiovascular system: risks and benefits’ published in CKJ will be discussed at the next CKJ Journal Club e-seminar.
How renal dysfunction engenders cardiovascular complications is still poorly understood. Notwithstanding interest on CKD is on the rise in the medical community at large, renal dysfunction remains a Cinderella in clinical research. To make a concrete example on the systematic overlooking of the cardio-renal link, more often than not, cardiovascular disease trials do not give information on the kidney function of participant patients. Disappointingly, the vast majority of these trials usually exclude patients with renal insufficiency. Even though the situation will probably change in the future, with notable exceptions, by now there are still few concrete signs that cardiovascular trialists take into proper consideration patients with CKD in the design of their studies. Indeed, the history is one of deliberate (but incomplete) exclusion. Even though the number of observational and mechanistic studies at the kidney-heart interface is now conspicuous, specifically designed research focusing on patients with both chronic kidney disease and cardiovascular disease appears to be a priority issue, on both clinical and scientific grounds.
The aim and scope of EURECA-m is to promote collaborations among European centres pursuing research in the overlapping area of cardiovascular and renal medicine.
Congresses are an important instrument for fostering scientific research because facilitate contacts and face to face discussions among clinicians and scientists. Scientific congresses of various sort prospered during the last decades as did scientific societies. Cardio-renal medicine already receives sufficient attention in international meetings by major scientific societies. While promoting communication between members and education (see below) are important goals of EURECA-m, it is not intention of the ERA-EDTA Working Groups to compete with or replace existing national and international societies (and other WGs) for the organization of congresses. Rather, EURECA-m aims at bonding with these Working Groups by joining and/or endorse well conceived meetings centred on the nephrology – cardiovascular medicine interface. EURECA-m will look rather at creating the opportunity for collaboration among and between nephrologists and other specialists. To this end a special type of Convention priorisiting the presentation of research proposals that have the characteristics of being feasible, relatively low-cost and of clinical relevance will be the centrepiece of the group. Creating shared databases is a concrete example of fruitful collaboration which may address relevant clinical research questions. Several research groups in Europe collected or are collecting 24h ABPM recordings in patients with kidney diseases or with hypertension or heart diseases along with detailed clinical information and outcome data. The same applies to measures of vascular involvement like pulse wave velocity or to cardiac imaging techniques from echocardiography to Nuclear Magnetic Resonance. Large databases are a tremendous opportunity for generating or testing scientific hypotheses. However, collection/merging data requires expertise in clinical epidemiology as well as in data management and statistical analysis. The range of databases that can be built is large and encompasses pre-dialysis and dialysis databases. For this reason EURECA-m will establish a special board of epidemiologists and biostatisticians that will be involved in collaborations of the kind and that will provide methodological input in study design, data collection/merging and statistical analysis. Investigator-initiated trials embedded in clinical practice represent another new possibility for effective collaboration among research groups aimed at advancing knowledge on cardio-renal medicine. Furthermore, basic scientists aimed at moving their bench observations into the clinical realm may find useful to present their data and ideas to clinical investigators that may help their research work entering the translational phase.
Promoting collaboration between different specialities: a step by step approach.
Collaborations between investigators from different specialties and effective bridging of interspecialty knowledge are complex issues which pose diverse challenges, from differences in the perception of priorities to difficulties related with setting common goals. EURECA-m will make a special effort to contribute at building up a common territory for nephrologists, cardiologists, hypertensionologists and diabetologists.
Identification of research priorities and education on cardiovascular and renal medicine.
While the ultimate goal of medical research is producing better clinical care, research is also an expression of freedom, serendipity and intellectual curiosity. Individual investigators pursue their research driven by their scientific interest and background and by external factors such as the academic environment where they work, funding and other considerations. It is widely perceived that identifying areas where research is most needed may serve to improve clinical medicine and help investigators at setting their aims and goals. This is a complex endeavour that can be accomplished by thorough analysis of existing knowledge face to face with major clinical problems in pertinent areas. Such an exercise is typically made by methodologists and guidelines developers after extensive literature review and careful consideration of the epidemiology and the clinical and public health impact of the conditions being analysed. Producing position statements and setting recommendations on priority research topics in the area of cardio-renal medicine is a goal of EURECA-m. In this respect, the European Renal Best Practice (ERBP) group by the ERA-EDTA has successfully started producing documents which provide guidance to the clinicians in everyday clinical practice. To avoid duplication of efforts and to prevent overlapping with ERBP activities, a collaboration scheme will be proposed to ERBP whereby proposals for position statements and documents of general interest by EURECA-M will be submitted and reviewed by ERBP.
EURECA-m aims at being useful to ERA-EDTA members and nephrologists in general. Therefore education is an important goal of this Working Groups. Educational endeavours by EURECA-m will prioritise courses on methodology and application of state of art instrumentation useful for research in this area. Special courses/meetings to support collaborative research projects will be designed when these approach the implementation phase.
Francesca Mallamaci (Italy) – Chair
Charles J. Ferro (United Kingdom) – Vice-Chair
Olga Balafa (Greece)
Lucia Del Vecchio (Italy)
Robert Ekart (Slovenia)
Patrick Mark (United Kingdom)
Patrick Rossignol (France)
Pantelis Sarafidis (Greece)
Alberto Ortiz Arduan (Spain)
José Manuel Valdivielso (Spain)
EURECA-m Advisor and LUST Study Coordinator
Carmine Zoccali -(Italy) – Advisor and LUST Study Coordinator from February 2012; Chairman from February 2009 till February 2012
EURECA-m External Consultant for Epidemiology in Cardiovascular Diseases in CKD
Ziad A. Massy (France)
Epidemiology and Biostatistics Consultants
Kitty J Jager (The Netherlands)
Friedo W Dekker (The Netherlands)
Giovanni Tripepi (Italy)
Cecile Couchoud (France)
Ziad Massy (France)
HOW TO JOIN THE WORKING GROUP
Being a ordinary member of the EURECA-m Working Group means being part of a network which facilitates exchanges of ideas on basic science research and new treatment protocols.
Becoming an ordinary member of the EURECA-m Working Group is FREE OF CHARGE (ERA-EDTA Membership is not mandatory) and is also open to non-nephrologists.
By joining the EURECA-m Working Group you will receive constant updates on the Working Group initiatives be included in the Directory of EURECA-m Working Groups’ ordinary members and start networking with colleagues from all over the world.
Over the last 3 years considerable strides have been made to consolidate the ongoing EURECA-m projects. Several opinion and consensus documents have been published in major journals (see below) having brought together the gathered expertise of EURECA-m Board members.
“Lipid management in patients with chronic kidney disease” this project involving current and past members of the EURECA-m Board has taken 2 years to complete but has now been accepted for publication in Nature Reviews in Nephrology. It is a massive document (>12000 words with >300 references) summarising the current state of knowledge on lipids in CKD/ESRD, assessing the potential impact of emerging lipid-modifying therapies and providing a critical appraisal of the now 5 year old guidelines produced by KDIGO.
The LUST Trial has now completed recruitment with 418 patients enrolled in the study from 20 European countries. The data is currently being collated and ancillary are currently being performed while the longitudinal follow-up is on-going. One of these “Inflammation Is an Amplifier of Lung Congestion by High LV Filling Pressure in Hemodialysis Patients: A Longitudinal Study” was accepted as poster presentation at the 56th ERA-EDTA Congress. The main paper is currently under review). The study will officially end in March 2020. Click here to read the protocol.
The EURECA-m ABPM Registry now has 6 participating centres with data from over 500 patients collected. Preliminary data was presented at the 2018 ERA-EDTA Congress with a full paper published in NDT. So far, 28 papers have been published on behalf of the EURECA-m Working Group. The group recently published the paper Apparent treatment-resistant hypertension in the hemodialysis population in the Journal of Hypertention.
EURECA-m CME – September 16-17, 2016 – Paris, France – click here to view the available educational material. EURECA-m CME – October 2, 2017 – Taormina, Italy) – click here to view the available educational materials. EURECA-m and CKD-MBD meeting – September 13-15, 2018 – Thessaloniki, Greece