2024-10-16 00:15:00
Interview with Roser Torra, president of the European Renal Association (ERA)
The president of European nephrologists explains that there are more diagnoses and better treatments for kidney diseases.
Roser Torra, in the premises of the Puigvert Foundation.
Although she had no family background in the profession, Roser Torra (Barcelona, 1965) decided at the age of 12 that she would dedicate herself to medicine. She was elected president of the European Renal Association (ERA), an organization representing 26,000 nephrologists.
She is an expert in hereditary kidney diseases.
My industry is booming because we have diagnostic means, because we see that a significant percentage of patients with chronic kidney disease are genetic in origin and we didn’t know it before, and therefore we couldn’t provide adequate care and treatment. And also because we have more and more treatments for these diseases. I would say that it is the area where the most important precision medicine exists among genetic diseases.
There is a lot of talk about research on cancer or neurodegenerative diseases. Is kidney disease a Cinderella?
In our environment we say that nephrology is not very sexy, compared to cancer, cardiology, neurology… For the public it is not spectacular because it is a silent disease, without symptoms, until the moment of dialysis or transplant. 10% of the world’s population suffers from chronic kidney disease and the vast majority are unaware of it. It is predicted to become the fifth leading cause of death in 2040. While cardiovascular disease, for example, is declining, kidney disease is increasing.
Because of increased longevity?
Increased life expectancy is a very important cause, and diabetes, which is the first cause. Globally, climate change or dietary habits also have a lot of influence.
It has been called a silent epidemic.
The silent epidemic, the elephant in the room… It’s absolutely true. The problem is that even among non-nephrology specialists some analytical data do not cause much concern. The entire population at risk – diabetics, hypertensives, obese, people who due to other circumstances such as the treatments received may have kidney diseases, genetic diseases – should undergo at least albuminuria and also periodically blood tests.
Are the costs high?
The health impact of kidney replacement treatment, i.e. dialysis or transplant, is very high. And it is not only a cost to the system, but also a cost in terms of quality of life and health.
What is the main line of ongoing research?
At the ERA congress in Stockholm, at the end of May, the most important clinical studies on drugs that slow down the disease in a spectacular way were presented, so spectacular that some studies had to be stopped because it was unethical to follow the placebo arm. This is a paradigm shift.
Who will be able to access it?
This is the big problem. There will be great inequality between countries. They are not very expensive drugs but, given that the volume of the population to be treated is high, we will see.
In the transplant we are fine.
We are number one. Right now Spain has brought forward an action in the European Parliament to improve the management of transplants at European level.
And as regards dialysis, where are we at?
There is a tendency to promote home techniques, but this also has a cost and difficulties for the system that should not exist because it is much better for the patient. Dialysis is much more effective than before, but it still requires spending hours a week on a hemodialysis machine or on peritoneal dialysis. The quality of life has improved in the sense that the patient is in much better conditions than a few years ago.
How important is the detection of rare kidney disease?
In nephrology there are genetic diseases and those of immune origin. These are diagnosed by kidney biopsy and have immunosuppressive treatments, while genetic ones are diagnosed through genetic studies. These studies were prohibitive a few years ago. At the Puigvert Foundation we were pioneers in Spain, now they have become very democratized and this allows us to diagnose many cases. We must try to diagnose, with a genetic study, especially in young people up to 45 years of age, a kidney disease whose origin is unknown.
Why did you choose to become a nephrologist?
I liked medicine, not surgery. Internal medicine is very broad and nephrology is the medical specialty most similar to internal medicine because, in fact, we deal with everything with our patients. It’s like internal medicine focused on the kidney. There is an important technological part, there are also the procedures (catheters, renal biopsy, ultrasounds, obviously the transplant), the genetic part, hypertension, immunological diseases… it has many different areas that make it a top specialization. Antonio Lopez Tovar (LV)
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