Interview with Prof U. Frei

Prof U. Frei Dept. Nephrology and Medical Intensive Care Charite - Universitätsmedizin Berlin Berlin, Germany

Prof Zoccali: You govern a large nephrology department in Berlin. Your research work deals with diverse areas spanning from acute and chronic renal failure to transplantation and has a strong clinical emphasis. Could you tell us the leading ideas along which your department was developed?

Prof Frei: In 1994 the medical departments of the University Hospital Rudolf Virchow (this was the name those days) have been reorganized. Based on skills from my training at the Hannover Medical School, I was assigned to head the combined nephrology and intensive care department. Given this chance we developed a clinical nephrology department, which is mainly dedicated to acute and chronic organ failure, renal replacement therapy and kidney transplantation. In these fields we have combined basic and clinical research.

Prof Zoccali: Undoubtedly large departments are the ideal soil for scientific cross-fertilization but pose complex managerial problems. Which is the main challenge for running a successful department like yours?

Prof Frei: Of course large departments carry chances but also a lot of burden to serve the other medical departments. The main challenge is the continuous exchange of staff positions, which is sometimes in conflict to create a steady research curriculum of the individual member. But based on very bright senior collaborators such as K.U. Eckardt, we were able to manage this successfully.

Prof Zoccali: Which is the ideal environment for a clinician involved in research and in patient care?

Prof Frei: It would be (but it isn't all the time) to have part time obligations for clinicians, with sufficient time to move in the lab. There are ample clinical questions still to be answered, in ICU nephrology as well as in RRT.

Prof Zoccali: Do you believe that there is a need for independent observational studies on clinical performance measures for gathering systematic information on the application of guidelines at national and European level?

Prof Frei: Yes, certainly. We are at the beginning to get a view on the ESRD population and there is still a gap between the care in the GP's office and specialized nephrology.

Prof Zoccali: Do you believe that this effort should be a goal of the ERA-EDTA registry?

Prof Frei: After having worked for a decade for the German Renal Registry QuaSi-Niere, I am a bit disappointed about the chances, and the compliance with registries. The only way to get sound data is through national quality assurance schemes with mandatory reporting, connected with reimbursement as it is done in the US. All other attempts are temporary.

Prof Zoccali: Presently which is the research topic at the top of the list in your mind?

Prof Frei: The accelerated atherosclerosis of ESRD and the excess mortality is the top priority of my list.

Prof Zoccali: Which is the scientific paper that influenced you most?

Prof Frei: Bob Wolfe's paper in NEJM 1999 about the prolongation of survival by renal transplantation. This paper in line with some others by H.U. Meier-Kriesche has to urge all nephrologists, to give as much as possible patients the chance to get a transplant soon.

Prof Zoccali: In Germany there is a blossoming of nephrology investigators that have gained a world-wide reputation. What in particular has favored the maturation of this first class generation?

Prof Frei: Based on a tradition of high-level basic researchers as K.J. Ulrich, K. Thurau and others clinical nephrology was established as a sub-specialty on faculty level in most of the university hospitals, which again attracted bright young scientists. There is a risk that this will not last, because nephrology in Germany has moved now significantly into private (dialysis) units, competing with university hospitals for interesting cases and even more replacing full time nephrology positions in hospitals by a consultation system.

Prof Zoccali: What would you envisage to increase the attractiveness of nephrology for talented young doctors?

Prof Frei: Besides good research opportunities, nephrology needs to keep tenure positions in academic medicine. Excellent support is given by some research foundations as Else–Kröner-Stiftung.

Prof Zoccali: Which is your favorite hobby?