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 promoting 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 WG 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 WGs by joining and/or endorse well conceived meetings centred on the nephrology – cardiovascular medicine interface. Specific instructions on this issue will be provided in the WEB site of EURECA-m (under construction). 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 WG. 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. We will act with a realistic attitude by firstly establishing a group based on members of the ERA-EDTA. Opinion leaders in
professional and scientific areas directly or indirectly related with cardio-renal medicine will be contacted only when the WG will have matured an initial program of projects, i.e. when the WG will have identified concrete possibilities for starting collaborative research projects.
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 (http://www.era-edta.org/images/ERBP.pdf) 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 WG. 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. A yearly educational course providing a critical overview of the literature will be organized in connection with the Annual Congress of the ERA-EDTA.
We will also explore the possibility of co-organizing educational courses with other national or international societies.
|3||REPUBLIC OF NORTH MACEDONIA|
|2||BOSNIA AND HERZEGOVINA|
|1||HONG KONG, P.R. CHINA|