编者按：在第62届欧洲肾脏协会（ERA）年会上，欧洲肾脏协会论文遴选委员会主席、荷兰格罗宁根大学医学中心医学教授Ronald Gansevoort接受了《肾医线》专访。他围绕年会论文征集情况、慢性肾脏病（CKD）分期更新、白蛋白尿筛查、相关临床试验等肾脏疾病领域的关键话题分享了见解，为我们展现了该领域的最新动态与未来方向。

全球投稿踊跃，ERA年会规模与国际化程度显著提升

ERA论文遴选委员会负责决定哪些投稿可在大会上展示，以及可以被接受，并遴选哪些研究在Late-breaking Clinical Trials（LBCT）环节交流。作为该委员会主席，Gansevoort教授介绍道，本届年会上，本届ERA年会的投稿数量创下历史新高，比上一次记录高出30%，且许多摘要都被接受展示。值得一提的是，中国提交的摘要总数排名全球第四，许多优秀的中国研究获得现场交流的机会。Gansevoort教授表示，ERA现已成为一个真正的全球性学术平台，这让他们倍感自豪。

Nephrology On-line: Would you like to briefly talk about your selection of the research to be presented at this ERA?

Dr Gansevoort: This year, we received a huge number of abstracts - the largest number of abstracts ever. Thirty percent higher than the last record. We also decided that many abstracts will be accepted for presentation here. By the way, China, I think, ranked fourth in line with the total number of abstracts, and many of these abstracts were accepted. We are very proud that the European Renal Association has now become a truly global meeting.

CKD分级更新的趋势：关注年轻人群肾脏功能异常

2011~2012年，Gansevoort教授参与了基于肾脏功能和蛋白尿的慢性肾脏病的新分级的制定，2023年KDIGO组织的新会议上，这一定义和分级体系再次得到肾脏病学界的认可。

目前讨论的一个焦点是，现行标准认为只有当肾小球滤过率（GFR）低于60 ml/（min·1.73m2）时肾脏功能才属异常。但年轻人的肾小球滤过率（GFR）若为70 ml/（min·1.73m2），就其年龄而言明显低于正常水平，尽管这与发病率和死亡率无关，却应明确这些年轻人存在肾脏功能异常，可能仍需要医疗关注。这是当前该领域正在争论的问题之一。

Nephrology On-line: Your work contributed to the development of the novel KDIGO definition and classification of CKD, as well as new clinical trial endpoints in nephrology. How do you envision future updates to CKD staging to better reflect disease progression and treatment response?

Dr Gansevoort: In 2011-2012, we made the new classification of chronic kidney disease that is based on kidney function and albuminuria. In 2023, KDIGO organized a new conference in which this definition and classification system was again accepted by the nephrology field. One thing under discussion now is that we say that only when kidney function is below 60 do we find it abnormal. Young people can have a GFR of let's say 70, which is clearly, for their age, lower than normal, and although not being associated with morbidity and mortality, it should be clear that these young people have an abnormal kidney function and may need medical attention. That is one of the things that is going to be debated at the moment.

白蛋白尿筛查：早期识别肾脏疾病的关键

在辩论发言中，Gansevoort教授强调应关注普通人群的白蛋白尿筛查，而非蛋白尿筛查，他认为“测量白蛋白才是未来的方向”。他们建议对人群进行白蛋白尿筛查，尤其是高危患者（糖尿病和高血压患者）。然而，从实际情况来看，不仅在荷兰、世界上许多国家（中国也不例外），糖尿病和高血压患者中接受白蛋白尿筛查的比例都相当低，导致肾脏疾病往往在晚期才被发现。

Gansevoort教授认为，他的使命是努力在疾病早期识别这些患者，以便开展早期预防，阻止病情向肾衰竭和心血管疾病发展。推动筛查的主要原因是太多此类患者未被发现，而人群筛查是解决之道。他们正在努力推进这一工作，在荷兰开展的一项大规模研究显示白蛋白尿人群筛查具有可行性，参与率接近60%，成本效益分析也表明该筛查具有成本效益。目前，他们正在开展一项涉及32万名受试者的大规模临床试验，受试者被随机分为筛查组和非筛查组，并对筛查组筛查发现的肾脏疾病进行治疗，研究将在5年和10年后对比两组结果，以确定通过筛查是否能有效预防疾病。

Nephrology On-line: In your debate presentation, you supported the promotion of proteinuria screening. What key clinical evidence supports its necessity, and what do you see as the main barriers and drivers for implementing this strategy globally?

Dr Gansevoort: Yes, it's not about proteinuria screening. It is about albuminuria screening of the general population. I think measurement of albumin is going to be the way forward, not protein. We advise nowadays that people should be screened for albuminuria, particularly the high-risk patients (patients with diabetes and hypertension). However, when you look at it, and that's our experience not only in the Netherlands, but in many countries across the world, and it will be exactly the same, I’m afraid in China, that the number of people with diabetes and hypertension that are screened for albuminuria is quite low, and that we discover kidney disease only at the late stage. My mission in life is trying to identify these patients at an early stage of the disease, hoping that we can start early prevention and stop progression towards kidney failure and progression towards cardiovascular disease. The main driver is that we are missing too many of these patients, and population screening, I think, would be the way forward. We are trying to develop this, and we did a large-scale study in the Netherlands looking at the feasibility of albuminuria population screening. It was feasible, with almost 60% participating. We did the cost-effectiveness analysis, showing that it was also cost-effective to screen for albuminuria. That was a pilot project, and we are now doing a really large-scale clinical trial in which 320,000 subjects are randomized either to screening or not screening. We are going to screen them, find new kidney disease, treat it, and then after five years and ten years, compare the results in the non-screened subjects versus the screened subjects as to whether we were really able to prevent disease in these subjects. That will provide the definitive answer, I guess. 

FLOW和SOUL试验：将改变CKD治疗格局

Gansevoort教授主持的一个研讨会对FLOW和SOUL试验的最新进展进行讨论。其中，使用司美格鲁肽的FLOW试验对肾脏病领域极为重要，其结果于去年在ERA年会上公布，并将影响未来指南的制定，司美格鲁肽等GLP-1受体激动剂有望成为慢性肾脏病患者的一线治疗药物。

Gansevoort教授指出，目前的一个挑战是，这些药物在糖尿病肾病患者中取得的良好效果是否也适用于非糖尿病肾病患者。去年的一项小型研究中，50例非糖尿病肾病患者接受司美格鲁肽治疗，50例不接受治疗，结果显示司美格鲁肽能显著降低白蛋白尿，但这只是替代结局（即白蛋白尿的变化），未涉及肾脏功能下降情况。目前制药行业正考虑开展针对非糖尿病慢性肾脏病患者的大规模Ⅲ期临床试验，这将对患者产生重大影响。

Nephrology Online: You are chairing a symposium that will discuss the FLOW and SOUL trials. From your perspective, how might the latest findings from these studies influence clinical strategies for CKD or ADPKD management?

Dr Gansevoort: The FLOW trial with semaglutide is going to be hugely important for our field. Last year, the results were presented at the ERA Congress. Very proud to have those results presented here. They are going to influence the guidelines that are going to be written. Semaglutide and the GLP-1 receptor agonists are going to be first-line treatment for patients with chronic kidney disease. Polycystic kidney disease, I don't know. There is little, if any, evidence for these drugs in PKD, so I don't see any indication there. One of the challenges will be that the beautiful results we had with these drugs in patients with diabetic kidney disease will also hold in non-diabetic kidney disease. Last year, we had a great short presentation, but that was in only a very low number of subjects. Fifty patients with non-diabetic kidney disease were treated with semaglutide, and fifty not treated. We saw a beautiful decrease in albuminuria with the drug, but it was only the surrogate outcome, change in albuminuria, without looking at kidney function decline. We need a definitive trial there, and I know from the pharmaceutical industry that, at the moment, they are considering starting a large-scale phase III clinical trial in patients with non-diabetic chronic kidney disease. That is going to be hugely impactful for our patients.

关注透析患者：ACHIEVE试验填补重要空白

作为“最新突破性临床试验Ⅱ”环节的主席之一，Gansevoort教授表示，今年大会收到了大量高质量摘要，因此设立了三场最新突破性临床试验专场。其中，Michael Walsh开展的ACHIEVE试验引起了他的特别关注，该试验研究了盐皮质激素受体拮抗剂在透析患者中的应用。“透析患者的医疗需求远未得到满足，其死亡率和发病率居高不下，但针对这一人群的临床试验极少”，“ACHIEVE试验是首批专门针对透析患者人群开展的大规模临床试验之一”，Gansevoort教授非常期待这一研究结果，它可能会为透析人群带来新的治疗希望。

Nephrology Online: ?As one of the chairs of the “Late Breaking Clinical Trials II” session, were there any presentations or studies at this year’s congress that particularly caught your attention?

Dr Gansevoort: Yes. We were fortunate that so many abstracts were submitted to the Congress, also of such high quality, that we could organize three late-breaking clinical trial sessions. One of the contributions that I'm very interested in will be the ACHIEVE trial by Michael Walsh looking at mineralocorticoid receptor antagonists in dialysis patients. Dialysis patients are the patients with the greatest unmet medical needs - high mortality, high morbidity rates, and very few clinical trials there. This is one of the first large-scale clinical trials specifically in this patient population. So, I look forward to seeing the results.