Raymond Vanholder: a titan of uraemic toxicity

Abstract

In November this year, Raymond Vanholder will step down as Head of the Department of Nephrology at the University Hospital Ghent, in Belgium, after more than 30 years at the beating heart of the European nephrology scene. But as is clear from his contributions in this issue of The Lancet—a Comment on renal replacement therapy and a Series paper on mortality risk in chronic kidney failure—he's not quite ready to leave the stage all together.There aren't many aspects of nephrology that haven't been influenced by Vanholder in recent times, but his clinical and basic research on uraemic toxicity in acute and chronic renal failure is widely recognised as his most important work. He founded, and until 2010 chaired, the European Uremic Toxin (EUTox) Work Group, which continuously updates the classification of all the known uraemic toxins and translates that knowledge into clinical nephrological practice. This vast undertaking was the result of Vanholder's “desire to classify and be structured, combined with his drive to organise people around a theme”, according to Wim Van Biesen, Vanholder's successor at Ghent and Chair of the European Renal Best Practice (ERBP) group. “Without these two skills combined in one person”, says Van Biesen, “this concept would not, or to a much lesser extent, be so widely accepted as it is now”.Born in 1949 in Ghent, Vanholder has lived in Belgium's Flemish East Flanders region ever since. Gifted at maths and chemistry at school, he had considered a career in both before opting for medicine. Swayed, he says, by his simple desire to help people. Vanholder stayed in Ghent to study at the city's university, but, after graduating in 1974, he found himself at something of a crossroads. “Surgery was out”, he says, because he was so “unhandy”, and he was leaning towards general practice before one of his tutors persuaded him to opt for internal medicine. It was towards the end of his internal medicine training that he spent a year under the supervision of P P Lambert at the Laboratory of Renal Physiology of the Queen Elisabeth Foundation in Brussels, where he got his first real taste of nephrology. He returned to Ghent to complete his specialist training in 1979, before joining the Department of Nephrology in 1980, where he's been ever since. Working first under the stewardship of Severin Ringoir until 1996, when his good friend and immediate predecessor as head of the department Norbert Lameire took over until 2005.Ask what has most characterised Vanholder's career at the forefront of nephrology, and more often than not you'll get the same reply: energy. Andrzej Wiecek, of the Medical University of Silesia in Katowice, Poland, speaks of Vanholder's “restlessness when something is not done immediately”, and “enormous power, always pushing him ahead”, and Van Biesen echoes those sentiments. “What is most obvious about Ray”, he says, “is his inclination to work hard, fast, and organised”.Such diligence and dedication not only gave rise to Vanholder's prodigious research output, but are also apparent in his involvement with European and international nephrology organisations. Until the summer of 2011 he was a member of the Scientific Advisory Board of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA), an organisation he has been President of since 2011. He was also Chairman of the ERBP group, and before that coordinated the European Best Practice Guidelines on haemodialysis, alongside other positions which include being the founding President of the Belgian Society of Nephrology.Perhaps one of Vanholder's proudest achievements has been his contribution to improving the treatment of crush syndrome. A disaster area might not seem like the most obvious theatre of operations for a nephrologist, but, in fact, one of the most effective ways of decreasing the death toll after disasters such as earthquakes and tornadoes is the successful treatment of the crush syndrome that arises from the compression of parts of the body of people who have been trapped in collapsed buildings. Rhabdomyolysis caused by crush syndrome can often result in acute renal failure if proper precautions aren't taken, and Vanholder has led efforts to produce effective guidelines. As Chair of the Renal Disaster Relief Task Force (RDRTF) of the International Society of Nephrology, he has helped coordinate several international relief operations. “My last time on the ground were the Marmara and Bam earthquakes in Turkey and Iran, which were very successful operations, but since then I've moved to a more coordinating role”, he says.The stewardship of the RDRTF, like that of the Department of Nephrology in Ghent, will be passing to Van Biesen later this year, but Vanholder will be staying on at the University as an Emeritus Professor, and will take up the Chair of the European Kidney Health Alliance from 2015. “I'll also be spending a lot more time doing sports and trying to stay healthy”, he notes, which is just as well, since his other abiding passion is gastronomy. “Raymond is a gourmet cook, particularly at the weekend”, says Lameire. It's safe to assume he'll have his plate full for years to come. In November this year, Raymond Vanholder will step down as Head of the Department of Nephrology at the University Hospital Ghent, in Belgium, after more than 30 years at the beating heart of the European nephrology scene. But as is clear from his contributions in this issue of The Lancet—a Comment on renal replacement therapy and a Series paper on mortality risk in chronic kidney failure—he's not quite ready to leave the stage all together. There aren't many aspects of nephrology that haven't been influenced by Vanholder in recent times, but his clinical and basic research on uraemic toxicity in acute and chronic renal failure is widely recognised as his most important work. He founded, and until 2010 chaired, the European Uremic Toxin (EUTox) Work Group, which continuously updates the classification of all the known uraemic toxins and translates that knowledge into clinical nephrological practice. This vast undertaking was the result of Vanholder's “desire to classify and be structured, combined with his drive to organise people around a theme”, according to Wim Van Biesen, Vanholder's successor at Ghent and Chair of the European Renal Best Practice (ERBP) group. “Without these two skills combined in one person”, says Van Biesen, “this concept would not, or to a much lesser extent, be so widely accepted as it is now”. Born in 1949 in Ghent, Vanholder has lived in Belgium's Flemish East Flanders region ever since. Gifted at maths and chemistry at school, he had considered a career in both before opting for medicine. Swayed, he says, by his simple desire to help people. Vanholder stayed in Ghent to study at the city's university, but, after graduating in 1974, he found himself at something of a crossroads. “Surgery was out”, he says, because he was so “unhandy”, and he was leaning towards general practice before one of his tutors persuaded him to opt for internal medicine. It was towards the end of his internal medicine training that he spent a year under the supervision of P P Lambert at the Laboratory of Renal Physiology of the Queen Elisabeth Foundation in Brussels, where he got his first real taste of nephrology. He returned to Ghent to complete his specialist training in 1979, before joining the Department of Nephrology in 1980, where he's been ever since. Working first under the stewardship of Severin Ringoir until 1996, when his good friend and immediate predecessor as head of the department Norbert Lameire took over until 2005. Ask what has most characterised Vanholder's career at the forefront of nephrology, and more often than not you'll get the same reply: energy. Andrzej Wiecek, of the Medical University of Silesia in Katowice, Poland, speaks of Vanholder's “restlessness when something is not done immediately”, and “enormous power, always pushing him ahead”, and Van Biesen echoes those sentiments. “What is most obvious about Ray”, he says, “is his inclination to work hard, fast, and organised”. Such diligence and dedication not only gave rise to Vanholder's prodigious research output, but are also apparent in his involvement with European and international nephrology organisations. Until the summer of 2011 he was a member of the Scientific Advisory Board of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA), an organisation he has been President of since 2011. He was also Chairman of the ERBP group, and before that coordinated the European Best Practice Guidelines on haemodialysis, alongside other positions which include being the founding President of the Belgian Society of Nephrology. Perhaps one of Vanholder's proudest achievements has been his contribution to improving the treatment of crush syndrome. A disaster area might not seem like the most obvious theatre of operations for a nephrologist, but, in fact, one of the most effective ways of decreasing the death toll after disasters such as earthquakes and tornadoes is the successful treatment of the crush syndrome that arises from the compression of parts of the body of people who have been trapped in collapsed buildings. Rhabdomyolysis caused by crush syndrome can often result in acute renal failure if proper precautions aren't taken, and Vanholder has led efforts to produce effective guidelines. As Chair of the Renal Disaster Relief Task Force (RDRTF) of the International Society of Nephrology, he has helped coordinate several international relief operations. “My last time on the ground were the Marmara and Bam earthquakes in Turkey and Iran, which were very successful operations, but since then I've moved to a more coordinating role”, he says. The stewardship of the RDRTF, like that of the Department of Nephrology in Ghent, will be passing to Van Biesen later this year, but Vanholder will be staying on at the University as an Emeritus Professor, and will take up the Chair of the European Kidney Health Alliance from 2015. “I'll also be spending a lot more time doing sports and trying to stay healthy”, he notes, which is just as well, since his other abiding passion is gastronomy. “Raymond is a gourmet cook, particularly at the weekend”, says Lameire. It's safe to assume he'll have his plate full for years to come. Renal replacement therapy: how can we contain the costs?The final stages of failing kidney function (known as end-stage renal disease) jeopardise survival and quality of life, but can be countered therapeutically by renal replacement therapy (RRT). Kidney transplantation offers the best outcomes but is not always possible, and even suitable transplantation candidates are often confronted with long waiting times. The alternative is dialysis—either haemodialysis, whereby blood from the patient is rinsed by an artificial kidney, or peritoneal dialysis, whereby rinsing occurs via the intra-abdominal peritoneal membrane. Full-Text PDF Epidemiology, contributors to, and clinical trials of mortality risk in chronic kidney failurePatients with chronic kidney failure—defined as a glomerular filtration rate persistently below 15 mL/min per 1·73 m2—have an unacceptably high mortality rate. In developing countries, mortality results primarily from an absence of access to renal replacement therapy. Additionally, cardiovascular and non-cardiovascular mortality are several times higher in patients on dialysis or post-renal transplantation than in the general population. Mortality of patients on renal replacement therapy is affected by a combination of socioeconomic factors, pre-existing medical disorders, renal replacement treatment modalities, and kidney failure itself. Full-Text PDF