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Progressive loss of renal function is a chronic process that typically evolves over decades. It ranges from mild, asymptomatic loss of function associated with normal ageing, to progressive decline associated with high cardiovascular morbidity and mortality, eventually necessitating renal replacement therapy by dialysis or renal transplantation.

After a renal transplantation, the process of progressive loss of function associated with increased cardiovascular risk continues to dictate outcome.

Effectively targeting chronic loss of renal function and its complications requires a multifactorial approach and a lifetime perspective in order to be able to account for the specific characteristics of each of the subsequent stage where each stage also carries the heritage of the preceding stages.

This multifactorial approach should identify synergistic targets for treatment, including both pharmacological and non-pharmacological, lifestyle and nutrition, interventions.

We cover the full range of investigative approaches, from basic science, via experimental and clinical intervention studies to clinical implementation, and dissemination in clinical care and society. This includes:  

  1. Experimental studies aimed at dissecting underlying pathophysiological mechanisms in animal studies, in in vitro cell culture conditions and in the human experimental set-up.  
  2. Intervention studies including pharmacological intervention, lifestyle intervention and a combination of these.
  3. Cohort studies to identify prognostic factors in the general population, populations at high risk for renal disease such as diabetes, and cardiac and/or renal patient populations, including native renal disease, transplant recipients and kidney donors.
Relevance

Nephrology a resource for expertise on lifestyle-monitoring and -management

A longitudinal, lifelong approach, spanning different stages of the lifeline, is at the core of research on progressive renal function loss and its complications. The data, resources, and concepts originating from such a lifelong longitudinal approach will be of great value for healthy ageing research in a broader sense.
 

Lifestyle monitoring

Lifestyle factors contributing to accelerated ageing, including nutritional factors, weight excess, lack of physical activity and environmental toxins, have enhanced impact in patients with renal impairment, by the poor homeostatic and buffering capacity of the kidney, with often easily apparent adverse clinical consequences. Hence, lifestyle-monitoring and lifestyle management, with emphasis on dietary intervention, has traditionally been a main focus in nephrology, with a strong tradition in secondary and tertiary prevention in patients with advanced renal disease where rigorous lifestyle management is a prerequisite for survival.

Impact outside the domain of advanced renal disease

Over the last years, the value of this expertise for application in larger populations, including earlier stages of renal impairment, patients with heart failure, high risk groups with diabetes and/or primary cardiovascular disease, and hypertension and overweight in the general population has been increasingly recognized. Thus, nephrology serves as a resource for expertise on lifestyle-monitoring and -management, that has immense innovative potential for elaboration outside the domain of advanced renal disease, into the domain of healthy ageing for larger populations.