编者按：Edouard L. Fu博士目前担任荷兰莱顿大学医学中心助理教授，主要从事肾脏病流行病学研究。在第62届欧洲肾脏协会年会（ERA 2025）上，他主持了慢性肾脏病（CKD）相关的两个专题会议。在接受《肾医线》专访时，Fu博士介绍了其深耕肾脏疾病研究的学术轨迹与前沿发现。

一、药物流行病学与肾脏疾病的交叉探索

早在博士后期间，Fu博士便在美国哈佛大学深耕药物流行病学，利用大数据评估心肾代谢疾病人群（包括心力衰竭、2型糖尿病及CKD患者）的用药安全性与有效性，重点关注SGLT2抑制剂和GLP-1受体激动剂等新型药物在大规模常规诊疗人群中的应用效果。

Nephrology On-line: We see that you have training at Harvard. Would you like to talk about your research interests at Harvard?

Dr Fu: Yes, I did a two-year postdoc at Harvard in Boston in the United States. There, I mainly worked on pharmacoepidemiologic research, so I used big data to investigate the safety and effectiveness of medications in people with cardiometabolic kidney disease (so people with heart failure, type 2 diabetes and CKD) and mainly looked at the effects of new drugs like SGLT2 inhibitors and GLP-1 receptor agonists in large routine care populations.

Fu博士介绍，期间他参与了多项重要研究。例如，他评估了SGLT2抑制剂在常规诊疗人群中的安全性，重点分析了临床试验中曾引发关注的不良事件，如SGLT2抑制剂相关的下肢截肢风险和酮症酸中毒风险。这些研究使我们明确了这类新型药物的安全性特征，为新药的真实世界安全性提供了重要证据，研究结果已发表在《美国肾脏病学会临床杂志》（CJASN）。

此外，他们研究小组还率先发现GLP-1受体激动剂有助于降低高钾血症风险（这是CKD合并其他疾病患者的常见并发症）。该发现填补了临床证据空白，相关成果分别发表于《英国医学杂志》（BMJ）和Kidney International。

Nephrology On-line: Did you publish any papers from your postdoc studies? Are there any interesting findings that you would like to share?

Dr Fu: For example, we looked at the safety of SGLT2 inhibitors in routine care populations. We looked at the safety signals that were maybe picked up by trials, such as lower limb amputations and diabetic ketoacidosis for SGLT-2 Inhibitors. In these studies, we basically established the safety profile of these new medications, and we published that in CJASN. Another study that I worked on was looking at whether SGLT2 inhibitors and GLP-1 receptor agonists lower the risk of hyperkalemia, which is a common complication in patients with CKD and coexistent comorbidities. Actually, we were the first paper in the world to show that the GLP-1 receptor agonists also reduce the risk of hyperkalemia. We published that in the British Medical Journal and another publication in Kidney International.

二、继续深耕药物流行病学，拓展GFR估算研究

回到荷兰，在莱顿大学医学中心，Fu博士的研究形成两条主线。其一是延续药物流行病学研究方向；其二是在哈佛大学时期研究的基础上，拓展了关于肾小球滤过率（GFR）估算的新研究方向。他特别关注不同的GFR评估指标（如肌酐、胱抑素C），并探索哪一种最更接近金标准测量的GFR，以及各类GFR估算方程在不同人群中的适用性。

Fu博士团队开展了大量研究，目前，他们正在系统比较多个主流GFR估算公式，包括欧洲肾功能联盟（EKFC）方程、新的CKD-EPI方程（2021年版，而非2009版），以期找到最适合不同种族和临床场景的GFR计算工具。

Nephrology On-line: And now you are working in Leiden University Medical Center. What is your study focus now? 

Dr Fu: I actually have two research lines. One focuses on pharmacoepidemiology, and I continue that line in the Netherlands. Another research line I also initiated in Harvard is focusing on GFR estimation, where I look at different filtration markers like creatinine and cystatin C, and look which one best approximates the gold standard measured GFR. We do a lot of studies comparing different GFR equations. There are a lot of new equations being developed, also in the European setting, like the EKFC (European Kidney Function Consortium) equation. Of course, there are new CKD-EPI equations - CKD-EPI 2021, rather than the older CKD-EPI 2009. So, we basically look which equation works best in which population. 

三、积极推进前沿课题，关注老年人肾脏治疗选择

提到团队近期研究新发现，Fu博士特别提及了一项令人兴奋的因果关系研究——比较老年肾病患者接受透析与保守治疗的差异。他指出，对于高龄、身体虚弱且选择不启动透析的患者，保守治疗正成为更可行的替代方案。去年他们在ERA年会上展示了这项比较透析与保守治疗的研究结果，并荣获最佳摘要奖。研究发现，即便在老年人群中，透析仍能显著延长生存期。下一步，他们将进一步探讨在哪些特定人群（如病情更严重或身体更虚弱的患者）中，透析的获益可能会减弱，从而为临床制定更精准的个体化决策提供数据支持。

此外，Fu博士还提到另一项令人期待的研究。他们团队正在分析实际测得的GFR（measured GFR）与临床结局的关系。这一领域目前尚缺高质量证据，因为绝大多数研究仅依赖于估算GFR（eGFR），而忽视了金标准的直接测量数据。相关论文目前正在整理投稿阶段。

Nephrology On-line: There might be some new findings not yet published. Are there any findings you can share in advance?

Dr Fu: There are many things I could talk about because there's so much research going on. One study I am really excited about is a causal study again where we are comparing dialysis versus conservative care in older adults. Conservative care is becoming a more viable alternative for people who are old and frail and may choose not to start dialysis. We presented last year at ERA and won the best abstract award there for our study where we compared dialysis versus conservative care. There, we basically found that dialysis prolongs survival even in older people. The next steps are basically that we are going to look whether there are any effect modifications, for example, in sicker patients or older, unhealthier patients where maybe their dialysis would not be beneficial. The second study that we are really excited about is that we are looking at the relationship between measured GFR and outcomes. Most studies have focused, of course, on eGFR, but the gold standard is measured GFR. We are finalizing that manuscript and it is hopefully going to be published soon.