Nephrologist Marc Vervloet has been appointed as professor of Nephrology at Radboud university medical center / Radboud University. His appointment follows his appointment as head of the Department of Nephrology at Radboudumc. Within his research line, he focuses on the consequences of chronic kidney disease, particularly the increased risk of cardiovascular diseases.
A staggering 1.3 million Dutch people have some kind of kidney disease. Their kidneys do not function optimally due to factors such as aging or an unhealthy lifestyle. Often, people are unaware of this chronic kidney disease for a long time. Clear symptoms only emerge when kidney function is less than 30%. We primarily recognize our kidneys as organs that filter waste products from our blood and excrete it through urine. Besides this, they play a crucial role in hormone regulation and maintaining a proper sodium balance in our bodies. Together with the heart, they also regulate our blood pressure.
Chronic kidney disease, even without the need for dialysis or a kidney transplant, is not benign. It leads to an increased risk of cardiovascular diseases, something many people are not aware of, as Professor of Nephrology Marc Vervloet explains. In cases of chronic kidney disease, waste processing is compromised. ‘Too many waste products remain in the blood, and the heart pumps these toxins around. Instead of chronic kidney disease, we could also speak of chronic blood poisoning, as that is essentially what is happening’, says Vervloet. This kidney disease results in the calcification of blood vessels, leading to an elevated risk of conditions like heart failure.
Chronic kidney disease is easily diagnosed through a blood test and urine sample. If kidney function is less than 60% or if there is too much protein in the urine, it indicates kidney disease and an increased risk of cardiovascular diseases. Vervloet emphasizes, ‘chronic kidney disease is, in fact, a risk factor for cardiovascular diseases, just like obesity and smoking. The only difference is that it's invisible. We must be more aware of it. Fortunately, cardiologists now often include an assessment of kidney function in their check-ups.’
The Role of Hormones in Cardiovascular Diseases
The question is which elements of chronic kidney disease lead to this increased risk. Vervloet has been researching this for years, both in the lab and with patients. His research has particularly focused on the mechanism by which changes in mineral processing, such as calcium and phosphate, lead to an increased risk of cardiovascular diseases. According to Vervloet, 'In animal experiments, we found that when the kidneys don't process phosphate properly, a certain hormone, FGF23, increases significantly. This is the hormone that rises the most with kidney disease. It directly leads to reduced heart function. It is one of the molecular mechanisms that can explain why reduced kidney function can lead to cardiovascular diseases, offering avenues for new treatments.'
A recent study by Vervloet also showed that a diabetes medication, an SGLT2 inhibitor, counteracts reduced heart muscle function in the case of chronic kidney disease. Vervloet states, 'We are learning more and more about the relationship between chronic kidney disease and the increased risk of cardiovascular diseases. Current treatment often focuses on lowering blood pressure and cholesterol, but discoveries like these provide opportunities for new therapies that are already being implemented.'
In addition, attention to and management of symptoms in chronic kidney disease are important pillars for Vervloet. He argues that through pain score questionnaires, we don't always uncover what truly matters to people. 'I saw a patient who mentioned having a bit of pain in her ankle. However, it turned out that, although the pain was bearable, it hindered her from doing what she wanted: walking to the bus stop to visit her grandchild. We need to pay more attention to the values that are most important to patients.’ This so-called value-based healthcare requires additional communication skills for doctors in the examination room. Vervloet concludes, ‘It's better for patients, and we can provide better healthcare.’
Marc Vervloet studied Medicine at the Vrije Universiteit in Amsterdam. He earned his PhD there with research on the disrupted metabolism of minerals in chronic kidney diseases (thesis: Managing disorder of bone and mineral metabolism in chronic kidney disease). After working as an internist for a few years, he specialized in nephrology and later became a professor of Experimental Nephrology. In November 2023, he made the switch from Amsterdam UMC to Radboud university medical center, where he became head of the department of Nephrology. Vervloet is one of the founders of the European working group focusing on the bone and mineral metabolism of patients with chronic kidney disease. He is also involved in the development and oversight of international nephrology guidelines as a member of KDIGO. His appointment as a professor of Nephrology is effective from December 1, 2023, for a period of five years.
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