Our highlights from the European Renal Association (ERA) Congress 2023

Contributing authors: Jonas Svensson, Director MR Imaging @ Antaros Medical and Paul Hockings, Senior Director MR Imaging @ Antaros Medical & Adjunct Professor @ Chalmers University of Technology

Last week’s 60th European Renal Association (ERA) Congress was held both virtually and in Milan from June 15-18. As the largest nephrology congress in Europe, there were over 9700 registered attendees. And as can be expected, there was plenty of exciting science presented and discussed, with regards to both clinical care and scientific research.

Antaros Medical was well represented with a presentation of data from our internal imaging method study, AM-01. We were also able to attend many interesting and informative sessions, presentations, and orals.

In this post we will be discussing 3 of our personal highlights from the congress and why we found them of particular interest.

Highlight 1: Fatty kidney and its implications for inflammation and CKD

The mini lecture given by Mehmet Kanbay as part of The Renal Riddle session provided a comprehensive overview on a topic that has been gaining significant interest in the field, fatty kidney.

His lecture covered the potential mechanisms that may lead to renal fat accumulation, how fatty kidney can lead to or cause kidney disease, possible shared mechanisms between fatty kidney and fat accumulation in other organs, and the possible ways to measure kidney fat.

Imaging techniques such as ultrasonography (US) and computed tomography (CT) have both been used to this end, though drawbacks such as operator dependency and low spatial resolution (US), and using of ionising radiation (CT) limit their utility. Magnetic resonance imaging (MRI) is an alternative imaging method with high specificity and sensitivity for adipose tissue and this is something we (Antaros Medical) are currently investigating in several ongoing clinical trials.

Fatty kidney is linked to adverse clinical outcomes such as albuminuria, decline in estimated glomerular filtration rate (eGFR), and incidence of chronic kidney disease (CKD). And while there are currently different hypotheses surrounding exactly how kidney fat accumulation is linked to kidney disease, the need for further studies investigating kidney fat is clear.

What we perhaps found most interesting was the suggestion that while there are potential shared mechanisms with liver and epicardial fat accumulation, there is also data that suggests independent mechanisms for fatty kidney, and furthering our understanding of these presents a very interesting avenue for future research.

Highlight 2: Development of new therapies to combat kidney disease

A common theme throughout the congress was the sentiment that “we live in exciting times for nephrology”, and this was strongly emphasised in the oral presentation by Masaomi Nangaku in the Updates on Current Management of CKD – what’s knew and where are we going session.

After indicating that nephrology is an outlier to the so–called ‘valley of death’ that plagues drug development, he described several breakthrough discoveries that have had a significant impact in the field of nephrology. These presented breakthroughs, including the cardio–renal association, hypoxia-inducible factor (HIF) and hypoxia of the kidney, and identification of SGLT2 and clinical application of its inhibitor, were chosen from a larger list that was compiled by the International Society of Nephrology (ISN) as part of its 60th anniversary in 2020.

The second half of the presentation described some of the recent efforts that have been made to streamline the translation of newly developed therapies against kidney disease from pre–clinical to clinical. This was a nice accompaniment to some other discussions throughout the congress that focused on ways we can better enable the clinical approval of new therapies, such as through academia–industry collaborations and consortia, and increasing efforts to identify better biomarkers to take to the regulatory agencies.

Limitations to the utility of biomarkers like urine albumin–creatinine ratio (UACR) or eGFR are well recognised, yet discovering and validating alternatives is crucial for ensuring new therapies can progress through the demanding drug development process and then be granted approval. This made us reflect on the important role imaging can play in the biomarker discussion.

Highlight 3: BOLD–MRI to assess (tubulo–interstitial) damage in CKD

Our final highlight for the congress is the oral presentation given by Menno Pruijm as part of the Hypertension, diabetes, cardiovascular diseases in CKD session. He provided an overview of the underlying physiology of renal tissue oxygenation, how blood oxygen level dependent magnetic resonance imaging (BOLD–MRI) works, and the clinical applications of BOLD–MRI for CKD patients.

The potential benefits of using BOLD–MRI in CKD that were presented, such as gaining insight into physiological processes and drug effects, and predicting outcomes, reflected our own thoughts on how imaging can further our understanding in kidney disease. BOLD–MRI is one technique that we use as part of our multiparametric MRI (mpMRI) protocol for imaging the kidney.

Some of the data presented touched on the predictive value of one imaging biomarker, called R2*, as an independent predictor of eGFR decline, which we found particularly interesting in light of our own work in assessing the predictive value of several imaging biomarkers and lab biomarkers in diabetic kidney disease (DKD). This work was presented in our abstract at the ERA congress. It was also very interesting for us to hear BOLD–MRI being discussed as a technique with potential value in clinical practice, in addition to its value in clinical trials for drug development.

In summary

In summary, while there were many sessions, presentations, and orals full of interesting research at this year’s ERA Congress, we chose 3 of our personal highlights to reflect on:

  • Fatty kidney and its implications for inflammation and CKD, Mehmet Kanbay
  • Development of new therapies to combat kidney disease, Masaomi Nangaku
  • BOLD–MRI to assess (tubulo–interstitial) damage in CKD, Menno Pruijm

We can’t wait to see what is presented and discussed next year at the 61st ERA Congress in Stockholm.

Blog disclaimer
The views and opinions expressed in this article are solely those of the contributing author/s. These views and opinions do not necessarily represent those of Antaros Medical.

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