Peter Stenvinkel | Professor of Nephrology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
Citation: EMJ Nephrol. 2024;12[1]:49-52. https://doi.org/10.33590/emjnephrol/CXAZ4342.
In 2020, Stanford University recognised you as the world’s 13th most influential nephrologist. Following your initial medical training, what led you to pursue a career in nephrology?
To be honest, it was the only place I got a job. But when I started to work in nephrology, I found it to be very diverse, with so many different aspects to it. It’s not just the kidneys; it’s also the heart, brain, gut, skeleton, and the immune system. The diversity was the reason why I wanted to continue working in the field.
As local congress President for the European Renal Association (ERA), how have you helped shape the 2024 programme and what are the most significant changes compared to the 2023 Congress?
I was part of the Organising Committee, and I think my part of the programme was to bring in some aspects of solutions that we can get from nature. We had a special session that discussed what we can learn from tigers and the Burmese python, how to generate water from fat, and lessons from the animal kingdom. Of course, we also had the plenary lecture by Barbara Natterson-Horowitz, University of California, Los Angeles, USA, an expert on natural solutions that we can help bring to medicine. I’ve been interested in this area for many years, and we are going to start a post-ERA meeting where we, the clinicians, and basic researchers, meet psychologists, veterinarians, and biologists to brainstorm about solutions from nature, and how we can bring that in to benefit humans.
I just published a popular science book about nature’s intelligence, discussing all these aspects. If we want to find solutions for what’s happening now on our planet regarding changes in the environment, we need to combine human intelligence with AI and nature’s intelligence, because there are many answers out in nature.
We are also launching a digital game at ERA 2024. Over 2.5 years, we have developed a new game in which health professionals can learn how planetary health works and connect the dots to learn how they best can change their prescription patterns, eating habits, and lifestyle to promote better planetary health.
What does the 61st ERA Congress’s overarching theme, ‘Rethinking Kidney Health and Transforming Kidney Care’, mean directly for nephrologists and indirectly for patients?
We need to include patients in everything we do, and I think that this is done more and more now. They are the persons we should work for, and so, rethinking kidney disease applies to both nephrologists and patients.
Is this theme aimed at more of a preventative approach, as opposed to an approach of treating when sick?
Yes, preferably, we should have preventive strategies, and I think the key areas are lifestyle habits. We need to live a more sustainable life and we need to change our eating habits. Of course, we also need to be more active and not as sedentary. It’s a growing concern among many of our children now in Europe and the USA, as they eat a lot of ultra-processed food, and they are not active enough. Transforming kidney care can be seen as more of a spotlight on some of the elements that physicians may not have focused on as much traditionally.
One of the ERA’s goals is to “educate the community about risk factors for kidney disease, lifestyle changes, and the importance of regular health checks” and to “promote healthy lifestyles.” What steps is the organisation taking to achieve this?
We have a number of lectures on that. We had a tent in Central Stockholm, where dietitians, nurses, and some doctors were in attendance to educate the general public about the importance of kidney health. They discussed dietary habits and measured blood pressure. I think we make need to make the public aware of how common chronic kidney disease is, and that it is possible to do something about it if it’s recognised early.
What new technologies and innovations being presented at the ERA 2024 Congress do you believe have the potential to significantly impact the field of nephrology in coming years?
AI is here to stay, and we really need to take advantage of the opportunities that this brings. I think kidney disease, and the science, will be much improved by AI.
Do you see a main area where you think it will take off initially?
Yes. In large studies with lots of data, help with processing data and spotting the patterns we can’t see ourselves will be valuable. We really need the help that AI can offer, because it’s a little beyond human intelligence.
In the recently published review you co-authored, entitled ‘Food as medicine: targeting the uraemic phenotype in chronic kidney disease’, what are the key messages for healthcare professionals?
Food contains a lot of bioactive nutrients. Some, there are way too many of, and some far too little of. In this paper, we discussed what we should eat less of and of course, red meat and ultra-processed foods are not good for our health or that of the planet. Following plant-based diets gives the opportunity to not only benefit our health, but also planetary health and the environment. So, here we have a win–win situation. If we can change the dietary habits and how we eat food, it will be an opportunity to benefit both our health and the environment.
Do you think it’s going to be quite a difficult mission to challenge people’s views around diets?
Yes. We will make an attempt at the Presidential dinner. It will not be an ordinary dinner, because we will test a menu that has been designed by one of Sweden’s top chefs, together with the World Wildlife Foundation (WWF), called The One planetary health plate. That plate has only taken 0.5 kg of CO2 to produce, compared to the usual 5 kg, or 10 times more if you have dinner with red meat in it. We await seeing how the guests will like this plant-based dinner with very, very low CO2 emissions and fingerprint.
You currently have more than 625 original publications and reviews to your name for your research in nephrology. What do you believe to be the current gaps in literature and what topics merit greater attention?
For transplantation, we know that the outcome has been much better. But after 10–20 years, the grafts start to work less and less well. We need ways to postpone this loss of transplant function. For this, we have the combination of lifestyle habits and maybe new drugs that target complement. This is a hot topic in nephrology. Of course, patients on dialysis have a very high mortality rate, and we need to find ways to postpone progression of kidney disease, so that less patients go on to dialysis. We are thrilled by the new drugs, the sodium glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists.
Have transplant populations been included in those trials?
That’s the problem. Now we need to find out if we can use these drugs that do so much good in the patients with chronic kidney disease, and see if we can use the same drugs for patients that are transplanted. I think we can, but we need to test that. The optimisation of kidney donors and donor-recipient matching is also very important.
You have received the Karolina Price award, the Vizenca award, and the Addis Gold medal for your research, but what has been the proudest achievement of your career?
My proudest achievement would be being a lecturer for students and finding out that they are interested in nephrology, asking questions, and starting to think about how they can improve for patients and their future career. I think motivating students is the most interesting part of working as a clinical doctor and researcher. This also involves trying to make them aware of the environmental situation, as working to lessen the CO2 footprint and eat more sustainably is something that will take up quite a large part of their careers.
