End-stage kidney disease is the final and most severe stage of kidney disease, meaning the kidneys can no longer filter waste and excess fluids form the body to sustain life. Renal replacement therapy takes over the essential functions of failing kidney, it is however no cure for kidney failure. There are two forms of renal replacement therapy; dialysis and kidney transplantation. The latter is considered the most effective form of renal replacement therapy. Our research in Amsterdam UMC is focused to reduce the cardiovascular burden and improve the quality of life beyond the standard of care of patients with end-stage kidney disease.
Our clinical research works toward preventing and curing cardiovascular diseases in patients with ESKD. Firstly, unraveling the mechanisms of cardiovascular disease in dialysis patients with the focus on prevention. Furthermore, in the future, we aim to offer patients a more tailor made treatment with regard to dialysis modality, dialysate composition, drug prescription, dietary advice, and new blood purification techniques. By using patient characteristics, we might be able to predict patient reported outcomes and treatment complications better. This would give us the opportunity to intervene before an adverse outcome has occurred.
Kidney transplantation
Kidney transplanatation remains the most effective form of renal replacement therapy. However, after kidney transplantation there is a lifelong need for immunosuppressive medication (medication that suppresses the immune system in order to prevent transplant rejection). This can be a burden for the transplant recipient because of risk of infections. Current research focuses on optimizing immunosuppressive medication, for example when the recipient is above a curtain age, it is investigated whether less immunosuppressive medication is superior. Another important area of research in kidney transplantation is to investigate a new therapy to reduce delayed graft function after transplantation. Delayed graft function refers to a condition in which the transplanted kidney does not start working immediately after transplantation, often requiring dialysis in the early post-transplant period. By improving early graft function, we aim to enhance long-term graft survival.
Personalised Kidney Replacement Therapies
In our multi-ethnic city and country, it is crucial to understand how genetic factors influence health. One important example is variation in the Apolipoprotein L1 (APOL1) gene, which can strongly increase the risk of kidney disease and is almost exclusively found in people with West African ancestry. In this project, we study how common APOL1 risk variants are in the multi-ethnic Healthy Life in an Urban Setting (HELIUS) cohort in Amsterdam, and what their consequences are for kidney health. Our findings will help healthcare professionals to better identify people at increased risk, improve counselling for living kidney donation, and prepare for future APOL1‑targeted treatments.
“Understanding the prevalence and consequences of APOL1 risk variants in our multi-ethnic population is essential for accurately estimating the impact on public health.”
E.H.C. van Schijndel, MD, PhD candidate Nephrology Amsterdam UMC
Dialysis
Dialysis research is primarily carried out in our ADRIC centre.
In our centrum experimental and clinical intervention studies with new dialysis modalities, dialysate composition, life style, diet, innovative drugs, and new blood purification techniques (e.g. apheresis and immunoadsorption) are currently enrolling. Here we study interventions directed to improvement of microcirculatory perfusion and end-organ functioning, better hemodynamic stability during and after the dialysis treatment, improved blood pressure control, prevention of thrombo-embolic, ischaemic and haemorrhagic events, and prevention of serious hemostatic derangements, including hyper or hypokalemia, dysnatremias, and acid-base disturbances among dialysis patients. Furthermore, clinical studies are aimed at prevention and treatment of cardiovascular disease, and heart failure in particular, in patients with ESKD. Finally, application of new apheresis and immunoadsorption techniques is an important focus in terms of new therapy indications, efficacy and potential adverse effects (e.g.g, acid-base disturbances).
