欧洲肾脏协会发展与肾脏病学前沿进展 | ERA大咖谈

编者按：Ivan Rychlik是布拉格查理大学内科教授兼某内科系主任，同时作为肾病学家，他在欧洲肾脏协会（ERA）担任过重要领导职务，包括八年的秘书长兼财务主管。这段经历让他深度参与了 ERA 的改革与发展，见证了协会在多个维度的显著进步。Ivan Rychlik教授接受肾医线采访，从 ERA 的发展战略到肾病学前沿疗法的探讨，Ivan Rychlik教授呈现了欧洲肾脏医学领域的组织变革与学术进展，为全球肾病诊疗的未来发展提供了极具价值的思考方向。

一、ERA 的发展变革与未来方向

在ERA的领导工作中，Ivan Rychlik教授参与推动了多项关键变革。在Carmine Zoccali教授和Christoph Wanner教授的先后领导下，ERA在各方面都有显著提升，主要发展体现在以下几点：第一，会员数量大幅增加；第二，ERA为会员提供的教育质量显著提高，教育资源覆盖范围显著扩大；第三，ERA学术会议水平提升显著，尤其是科研水平大幅提高；第四，作为财务主管，他特别提到，ERA实现了财务盈利，这为各项会员服务提供了坚实的资金保障。

Nephrology On-line: You’ve played a key leadership role in the ERA over the years, including as Secretary-Treasurer. What changes in the organization’s direction or focus have you observed, and where do you see it heading post-2024?

Dr. Rychlik: I spent eight years being in the leadership of ERA. As you mentioned, in the position as the secretary treasurer, and during that time, we changed the society quite a lot. Everything started under the leadership of Professor Carmine Zoccali, and then later on, continued by the leadership of Professor Christoph Wanner Generally said, we really improved in all activities of ERA and what developed the most was following: the first is the membership itself, which dramatically increased, The second, educational qualities were our buddies which were delivered in a wide range to our members.

The third, it was the quality of the ERA congresses, which improved quite a lot, particularly increasing the level of the scientific quality. So that was achieved. And the fourth, which I would like to mention because I also served as a treasurer, that we were able to achieve the financial profit, which allows us to use our money sources for all these activities, which are delivered by ERA to their members.

二、ERA在医学教育拓展上的创新实践

鉴于欧洲不同地区在医疗发展上的差异，ERA将致力于向所有会员，尤其是年轻医生，更广泛地传播肾病学知识。

Ivan Rychlik教授谈道，针对欧洲医疗资源分布不均和年轻医生会员费负担问题，ERA推出了两项关键举措。其一，与国家协会合作推出联合会员计划，年轻医生仅需支付4~8欧元的小额费用，即可同时成为国家协会和ERA会员，并自动享受所有会员福利，包括每周远程会议和电子研讨会在内的教育资源，这些活动多围绕当下重要治疗话题展开。实践证明，这是让年轻医生获取教育资源的有效方式。其二，开发针对年轻医生的电子教材，全书约30章涵盖肾病学全貌，并每年更新内容，确保收录最新医学进展。这两项举措成效显著。

此外，ERA还积极组织大型继续教育（CME）活动，如在大会前一天举办的CME，设有8个专题，场场爆满。参与者先进行一天的集中培训，再参与为期三天的正式大会，形成了“教育+学术”的复合型参会模式。

Nephrology On-line: You talk about the membership and education. How can ERA expand the education for training purpose? How can ERA improve it?

Dr. Rychlik: You should still consider that Europe is diverse. So generally, the whole continent is developed, but there are still some differences between East and West and so on. So, one of our target is to distribute and to disseminate the knowledge of the nephrology to all members, or particularly to juniors. And we found out that a lot of juniors are not members on the society because, of course, there was some membership fee needed which was high enough to be paid by them . So that was a big and important decision, that we decided to cooperate with the national societies. We offered them the joint membership when they paid a small amount of money, like 4 - 8 euros, or that amount for per single member, and then they became the members not only of the national society, but also the member of the ERA.

And automatically, due to that, all members benefits are delivered to them, and that it was proof as a good way how to allow these juniors to get the materials which are used for the education for example the teleconferences and E-seminars. So these are organized mostly on a weekly base, and a lot of them are on contemporary topic, which are very much important for current use of the therapies. And then the second, what was achieved was the creation of the e-book, which is actually the electronic book, like a textbook which is targeted to juniors.

And the whole Nephrology is covered just now in about 30 chapters. And these chapters are designed for juniors, but they are updated on a year base. So if there is something new, it is written again to the new edition of this e-book. So I would say that these are two major activities which were proved as a very active one. And then we started to organize big events, which are the CME events. And one out of them are those CMEs which are held just day before the Congress. There are eight tracks, and every tract is highly crowded, as you can see here in the Congress. So the rooms are full, and then the people spend one day being educated, and then they continue three days with the Congress. So to sum up, this is probably the most activities which were now developed under the umbrella of the ERA.

三、肝肾综合征与急性肾损伤的新进展对临床决策的影响

谈到这一问题，Ivan Rychlik教授指出，本次会议聚焦于肾脏疾病，而CKD和AKI也存在于其他类型的患者中，这是患者多器官受累的一部分。从这个角度看，慢性肝病患者（主要是肝硬化患者）是临床实践中的重要群体。尽管与其他疾病群体相比，他们的数量相对较少。近年来，肝肾综合征与急性肾损伤领域取得了一些新进展，这也是他受邀分享这一主题的原因。值得关注的是，过去几年一些新药物研究和临床研究文献发表、新指南更新，对这一群体患者的治疗方案提出了建议，尤其是针对难治性患者群体。

Nephrology On-line: In your session on Hepatorenal syndrome and AKI, you discuss new developments. How do these advances influence clinical decision-making for patients with liver-kidney interaction syndromes?

Dr. Rychlik: That's a very right question, because it’s nicely illustrated that this conference is about the kidney diseases, but CKD or AKI are also present in other type of the patients. This is just part of the multi organ involvement of our patients, and from that point of view, so called the chronic liver patients, which are mostly covered by the cirrhotic patients, are a significant part out of our practice.

But comparing the other situation, of course, they are much rare due to the other groups. But anyway, there are some new developments which could be applied, and that's a reason why I was invited to talk about this topic, which is anyway interesting, because there are some new drugs and some new papers which were published in the last and of course, there are some new guidelines which recommends how to adjust the treatment, In particular, this very difficult group of the patients to treat.

四、细胞和基因治疗在肾病临床实践中的应用前景

本次ERA大会上有专题演讲阐述了细胞和基因治疗在肾病治疗中的应用。概括而言，遗憾的是，尽管我们拥有很多新的治疗方法，但它们大多价格昂贵。由此，还会引发一系列问题的其他问题，包括：第一，我们是否有足够资金覆盖这些治疗？第二，哪些患者真正适合接受这些治疗？其中是否有一部分患者可归为罕见病范畴？第三，与这部分治疗活动紧密相关的伦理问题。伦理问题可能尚未被广泛深入讨论。治疗过程总是伴随着诸多伦理方面的考量，因此，Ivan Rychlik教授认为还有很多问题仍待讨论，必须继续深入研究。当然，这是一个极具启发性的话题，因为我们现在能够治疗10年前可能无法医治的患者，这是了不起的进步。

Nephrology On-line: Your plenary talk addresses cell and gene therapy in clinical practice. From your perspective, how close are we to integrating these therapies into routine nephrology care?

Dr. Rychlik: It's a very good and important question. Actually, disciplinary talk will be delivered today, and we are waiting what we are giving as information. But to sum up that topic, unfortunately, we have a lot of new therapies, but the “dark side” is that they are mostly very expensive. And then one can have a lot of additional questions. First of all, of course, do we have the money to cover the therapies? Then the second, who are the patients who are really indicated for them, and part out of them could be covered by the rare diseases?

This is a good example. And the third, which is probably still not discussed so much largely is the ethical issues which are very tightly connected with that part of the treatment activities, because always there are a lot of ethical questions. So I think that a lot is still under discussion, we have to work on that. But of course, it's a very stimulating topic, because we are now able to treat patients which were not treatable just maybe 10 years ago, you know? So this is something amazing.