From WEDA To EDTA To ERA: 60 Years Of Supporting European Nephrology And Counting

ABSTRACT

Nephrology has evolved from treating kidney failure, first with dialysis and then with kidney transplantation, to identifying and treating early stages of kidney disease and eventually to preventing kidney disease from occurring. Similarly, the name of the European scientific society caring for people with kidney disease has evolved from the West European Dialysis Society Association to the European Dialysis and Transplant Association to the European Renal Association. These name changes reflect a deeper change in the mission of the society to the current mission of leading European nephrology by promoting kidney health for all, improving kidney care for patients, and strengthening the kidney community and the vision of a Europe where kidney health is prioritized, kidney health is accessible and the kidney community is thriving. We now review the major changes in society over the years and present its current structure and focus as we face the largest projected increase to date in the global burden of kidney diseases.

Keywords: kidney disease, kidney failure, nephrology, prevention, renal replacement therapy

INTRODUCTION 

From the time when the West European Dialysis Association (WEDA) was founded in 1963 until today, the European Renal Association (ERA) has constantly been evolving and adapting its activities to maintain its role as a backbone of the European nephrology community. The association will soon be marking its 60th anniversary, presenting an occasion to honor the past and anticipate future trends in creating equitable access to sustainable renal health care.

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HISTORY OF THE ASSOCIATION

The early history of ERA began in the 1960s when Stanley Shaldon, William Drukker, and David Kerr foresaw that the future of nephrology would require more activity in the technical aspects of treating humans rather than just academic interest and animal research. The first successful maintenance hemodialysis treatments have only just begun, with no ultimate therapy for end-stage kidney disease (ESKD) other than transplantation, which was pioneering at the time. The idea to form a European Association for Dialysis was conceived during an International Symposium on Acute Renal Failure, organized by Shaldon at the Royal Free Hospital in London, in 1963. It was during this meeting that Kerr suggested to Shaldon that there should be an annual symposium on dialysis, bringing together nephrologists from all over Europe. A similar idea had been proposed to Shaldon by Drukker at the meeting of the West European Clinical Chemistry Society a year earlier.

The three experts (Fig. 1) thus created the WEDA, envisioning it as a small association, with a limited number of active members from a few Western European countries [1]. Later that year, Gabriel Richet suggested name alteration to avoid raising suspicion of being politically biased, and so the European Dialysis and Transplantation Association (EDTA) was born [1]. The first EDTA congress, which took place in Amsterdam in 1964, was a great success, with guest lecturers such as Willem Kolff and Sergio Giovannetti, and 210 participants from 16 European and several non-European countries, including the USA, Australia, Panama, and Ghana. The first EDTA Constitution was drafted (Table 1), and the association logo, created by Shaldon, was presented on the same occasion (Fig. 2).

On EDTA’s 5th anniversary, in 1968, the Paper Selection Committee was established and the first ‘Annual Report’ was presented to the members. This report included the Directory of Members with the list of European dialysis centers. The anonymous abstract selection procedure for the annual congress was introduced in 1969. The proceedings of the 1977 congress for the first time included summaries of the poster presentations, which were allotted 8–10 min of chaired discussion time at the congress itself. In the same year, a close collaboration between the national nephrological societies and EDTA was initiated. With the evolvement of clinical nephrology and with the idea of including all the specialties linked to nephrology that were growing rapidly in those years, the society name was further modified from EDTA to EDTA-ERA in 1981, thus adding the ERA to the name/acronym. Two years later, at the 1983 congress, for the first time, the abstracts related to clinical nephrology extended those dealing with dialysis. Thanks to the fine diplomacy of Vittorio Andreucci, the then-president of the society, later that year nephrology was officially acknowledged as one of the key missions of the EDTA, deserving a more prominent role in the society’s name, and EDTA-ERA became the European Renal Association-European Dialysis Transplantation Association (ERA–EDTA) [2].

In 1990, Vincenzo Cambi was elected as Secretary–Treasurer, and he decided that it would be much more efficient to have a permanent secretariat office that could support with professionally hired staff the ever-growing membership as well as the Council and the many growing and new initiatives. It was thanks to Cambi that, in 1991, the society’s HQ was established in Parma (Italy).

The year 1996 was significant in ERA-EDTA’s history as the society established a new constitution, fully incorporating the Registry and the Nephrology Dialysis Transplantation (NDT) journal. In the following year, the ERA-EDTA became an English and Welsh charity, thus moving its legal residence from the Netherlands to the UK. In the same year, Michèle Kessler from France became the first woman to be elected as an ordinary Council member. In 2002, the society instituted Continuing Medical Education (CME) programs, and in the following year, scientific research was added to the statutory aims of the association in the constitution. Furthermore, the Scientific Advisory Board (SAB) was created to support the Council in the evaluation of future fellowship and research programs. The ERA-EDTA Ethics Committee and the first Working Groups were established in 2009, and in 2013, the Committee for International Affairs (ComIA) and the Young Nephrologists’ Platform (YNP) were founded.

Closely keeping up with the new technological developments, the digital transformation of society began as early as 1996, when the ERA-EDTA website was introduced. From 2002, a freely accessible educational journal is published online, and NDT-Educational and congress abstracts were submitted in the same way. The association introduced an app at the 2012 annual congress in Paris. One year later, on the occasion of its 50th anniversary, the digital modification of ERA-EDTA continued with the introduction of Follow Us Flash, a biweekly electronic newsletter. In 2016, ERA-EDTA began with social media activities by endorsing tweeting activity and launching the European Nephrology Portal (ENP).

The year 2018 brought more innovation into ERA-EDTA. The society introduced a completely new logo, with a more vibrant color code, albeit keeping the Leading European Nephrology strapline. Also, several new committees were formed. The Continuing Education and Professional Development (CEPD) committee replaced the old CME committee. The Scientific and Educational Interaction Day (SEID) committee was appointed to organize a new educational and interactive day to be held separately from the Congress. Finally, the Green Nephrology Committee, the Nephrology and Public Policy Committee, and the Electronic Communications Committee were founded. Ultimately, in 2021, a major change of the organization’s name was introduced, supported by a majority vote of the membership and reflecting the drift towards modern-era communications. The new name is short, practical, and easy to spell, and highlights the organ that lies at the very foundation of the nephrology practice and science. The ERA was finally born (Fig. 3).

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MISSION AND VISION

ERA’s latest mission and vision reflect its fundamental and connecting role in European nephrology (Table 2). This specialty is truly becoming more essential with population aging and the increasing prevalence of diseases that lead to chronic kidney disease and renal failure, which are estimated to become the 5th global cause of death by 2040 [3]. In previous years, ERA sought to expand its efforts to promote nephrology as a crucial, constantly evolving medical discipline that integrates clinical practices, basic science and scientific research.

Table 2. ERA’s mission and vision were approved at the Council Meeting in December 2021 

The organization has set up several important goals for the future: to promote public awareness of kidney diseases and develop a global outlook to kidney health; to facilitate the equity of access to kidney health, diagnosis and treatment, especially in the neglected regions and populations; to respect and enhance patient voice and choice; to stimulate innovative research related to kidney health and care; to foster a stronger sense of identity and community among the association members; to harmonize and standardize good nephrology practice across Europe through educational programs; to inspire the future generations by reimagining the role of a modern nephrologist and to address the pressing issues of nephrology workforce recruitment and retention. The ultimate goal set for ERA in the forthcoming years is to be perceived as an umbrella for the

European nephrology community that connects professionals through continuous education and scientific projects.

ERA MEMBERSHIP 

In its founding year, EDTA had 82 active members. On its fifth anniversary, in 1968, the number had already risen to 490 members and continued to grow at a steady pace, reaching 700 in 1971, 1200 in 1979, and 7000 in 2014. The association currently has >6500 active members, making ERA one of the largest nephrology societies globally (Fig. 4). ERA cherishes collaboration with national nephrology associations and has installed several incentives and membership benefits to enhance its network. Medical students under the age of 28 enjoy free membership, and trainees (>40 years of age) have their own committee (YNP), and special dedicated initiatives and are fully integrated into all the initiatives and committees of the Society, as well as a very low discounted annual membership fee, while other members are entitled to discounted article processing charges in the NDT journal, Clinical Kidney Journal (CKJ) and medical books published by Oxford University Press. All members can enjoy numerous other privileges related to educational, scientific, and networking ERA activities (Table 3).

ERA REGISTRY

The ERA Registry is one of the most important endeavors of the society [4]. The first Registry Committee was appointed at the congress in Amsterdam in 1964, with William Drukker as its first Chair. Merely a year later, the first Registry report presented data on 271 chronic renal patients on Renal Replacement Therapy (RRT) from 41 European nephrology centers, 258 performed renal transplant procedures, and details on 187 transplanted patients. The Registry soon became a marvelous example of international cooperation, and in 1986 already provided data from 82% of all European renal centers, including 111 300 patients living with the support of either dialysis or a functioning transplant. In 2000, the ERA-EDTA Registry moved from London to Amsterdam at the Amsterdam Medical Centre (AMC), and the procedures for collecting and processing data were thoroughly transformed. The pediatric registry was first added to the ERAEDTA in 1971 and was later restored in 2007, thus creating the ESPN/ERA-EDTA Registry thanks to an agreement between the European Society of Pediatric Nephrology (ESPN) and ERA-EDTA. The Registry now provides the most comprehensive record on the care of patients requiring RRT, relying on the voluntary devotion and commitment of the renal centers [5].

LEADING EDUCATION IN NEPHROLOGY—ERA CONGRESS AND BEYOND 

Education through ERA meetings

The major ERA-endorsed educational and networking event is the ERA Congress, with a tradition spanning >50 years. The congress evolved from a one-day event to a large-scale, multiple-day occurrence with ten parallel sessions, poster presentations and thousands of participants from both European and non-European countries. Today, the congress focuses on key learning features in clinical practice, as well as on the scientific advances and latest technical innovations in the field of nephrology. The papers presented at the annual congresses were initially published in the EDTA Proceedings, which grew in parallel with the number of participants [4]. In 1986, the proceedings were replaced by the peer-reviewed NDT journal [2].

In the past decade, the congress has been held in alternate parts of Europe, moving to different regions by rotation: in Prague (2011), Paris (2012), Istanbul (2013), Amsterdam (2014), London (2015), Vienna (2016), Madrid (2017), Copenhagen (2018) and Budapest (2019). In 2020, ERA-EDTA had to quickly adapt to the new circumstances imposed by the COVID-19 pandemic. By switching from a traditional live form to a fully virtual one in merely 11 weeks, thus neither canceling nor postponing the event, ERA successfully rose to this unprecedented challenge. The 2021 Congress was also fully virtual and still gathered participants from all over the world (Fig. 5), but the 59th congress in 2022 is expected to take a hybrid form and proceed both virtually and face-to-face, heading back to Paris. Based on the positive experience with the virtual component imposed by the pandemic, the Council has decided to keep a very strong virtual component in the future annual congresses, thus making them more inclusive and sustainable.

The congress scientific program continues to cover most aspects of nephrology and attempts to provide focus on issues that are most important in both clinical practice and science.

The 2021 congress had four plenary lectures, 33 free communications sessions, 31 industry symposia, eight CEPD courses, four mini-oral sessions, and two hands-on courses. The virtual format presented an opportunity for all participants with an accepted abstract to gain more visibility by presenting their work as a mini-oral presentation. Selected congress lectures were covered by summary reports published on the Nephrology Education Portal (NEP), the former NDT-Educational e-journal, which significantly increased their visibility. In the last years, ERA has been dedicated to increasing the sustainability of congress activities, with an accent on the simplification of logistics, organization and environmental awareness.

ERA’s many other activities in education, research and advocacy, such as CME courses, NEP summary reports, the SEID, journals, etc., aim to provide healthcare professionals with straightforward information on the innovations in nephrology. ERA’s working groups are dedicated to chronic kidney disease and mineral and bone disorder (CKD-MBD), Developing Education Science and Care for Renal Transplantation in European States (Descartes), European Renal Nutrition (ERN), Diabetes and Obesity (DIABESITY), European Dialysis (EUDIAL), European Renal and Cardiovascular Medicine (EuReCa-M), Immunonephrology (IWG) and Inherited Kidney Disorders (WGIKD). They encourage research, communication of knowledge, teaching and education in the nephrology community (Fig. 6). All working groups regularly organize educational meetings and seminars throughout Europe, but recently most of the groups have transferred their activities to online educational activities using the society’s successful e-seminar series. Starting in 2020, these e-seminars have focused on hot topics in the field of nephrology and related subjects, including the nephrology-related aspects of the COVID-19 pandemic. The Descartes working group also organizes Clinical Transplantation Day (CT Day), an educational event dedicated to disseminating knowledge on current practices in kidney transplantation. This year, the fully virtual 7th edition of CT Day focused on the new insights related to the COVID-19 pandemic, with an emphasis on how to optimize the chances for transplant patients in the aftermath of the pandemic. Furthermore, the CKD-MBD group continued with the European Renal Osteodystrophy (EUROD) Winter meetings, albeit in a fully virtual format.

Another ERA educational initiative, introduced in 2019, the SEID, is a meeting that boasts educational lectures focused mainly on clinical issues, from diagnosis to prevention and therapy. Sessions at the first SEID meeting focused on systemic diseases affecting the kidney (ANCA-associated vasculitis, lupus nephritis and anti-GBM disease), updates on recent studies related to the treatment of anemia, hyperkalemia and diabetes, ethical aspects of using genetic results in clinical daily practice, and stimulating discussions on patients’ and nephrologists’ considerations on the choice of kidney failure treatment. The conference also included practical sessions, involving demonstrations of ultrasound scanning and fistula imaging on real patients. SEID is expected to continue as soon as the epidemiological situation allows it.

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