Interview with Prof N. Levin

Prof N.W. Levin Medical and Research Director of Renal Research Insitute New York, USA

Prof Zoccali: You had your education and started your career in South Africa, a country with solid medical tradition. Could you tell us which were the stimulus and the triggering event, if any, for you to move to the USA?

Prof Levin: There was not much intention to leave initially. However, after my return from my fellowship with Dr Robert Kark and Dr Victor Pollak (of kidney biopsy fame) in Chicago, I received an offer by Dr David Earle to begin a new program at Northwestern University. Initially this was to be temporary but it turned into permanent immigration to the USA.

Prof Zoccali: You founded an Institute dedicated to the study of Renal Disease. How did the idea of this Institute materialize in your mind?

Prof Levin: The idea of combining a group of dialysis units in universities with a central research laboratory to jointly carry out clinical research and advance technology was formed with Ben Lipps, who is now CEO for Fresenius AG and one of the original patentees of the hollow fiber kidney.

Prof Zoccali: How did you recruit the initial research team of the Renal Research Institute?

Prof Levin: We began by inviting Daniel Schneditz Ph.D., who is now a prominent scientist at the University of Graz, to head our laboratory in New York while we constituted research collaboration with the Universities of Michigan, California (San Francisco), North Carolina and the Albany College of Medicine and College of Pharmacy. Subsequent leaders of the laboratory have included Dr Claudio Ronco (Italy), Dr Frank Gotch (USA), Dr George Kaysen (USA), Dr Nicholas Hoenich (UK) and Dr Roger Greenwood (UK) and currently Dr Martin Kuhlmann (Germany). We added the University of Rochester later after withdrawing from UCSF.

Prof Zoccali: Do you still have time to devote to clinical medicine or are you entirely absorbed by your scientific and managerial duties?

Prof Levin: I see occasional patients on consultation in an out-patient facility. It is most enjoyable work.

Prof Zoccali: The distance between basic and clinical research is widening. Do you think that it is more difficult now for young investigators to acquire a “from the bench to bedside” experience?

Prof Levin: Yes, there are few individuals who truly excel at both. The development of molecular biology as opposed to working at an organ or tissue level has increased the distance between the bench and the bedside. I believe that at the same time, the art and skill of history taking and physical examination has deteriorated (but it would not be surprising if physicians had the same thought 60 years ago).

Prof Zoccali: Which research projects are you running in your institute, and which is presently the project at the top of your interests?

Prof Levin: We are working in a number of fields related to dialysis and chronic kidney disease at present including:

1.  Participation in an NIH-sponsored trial of in-center daily hemodialysis.

2. Estimation of dry weight in Hemodialysis Patients by continuous intradialytic segmental bioimpedance analysis.

3.  Body Composition: Validation of segmental bioimpedance (SBIA) as a tool for improving the direct determination of body composition in dialysis patients. We are collaborating closely with Steven Heymsfield and Jack Wang at Roosevelt-St. Luke's Hospital in New York on detailed body composition analyses in dialysis patients which include visceral fat, visceral volume, liver spectroscopy, K 4O , D 2 O, Bromide, Dexa and MRI studies which will lead to more accurate equations to characterize body composition in health and for use in the clinic, in rehabilitation and the gymnasium.

4. Vascular Access: Angle independent-Doppler for vascular access monitoring (angle independent doppler).

5. Phosphate metabolism: A study of the feasibility and utility of long term modeling of inorganic phosphorus mass balance in HD therapy.

6. Inflammation and Periodontal disease: Mortality of dialysis patients and relationship of general population mortality.

7. Epidemiologic internal studies on the relationship of dialysis mortality to general population disease and mortality.

2 and 3 above are our main focus.

Prof Zoccali: Which are the scientific papers that had the greatest impact on your scientific projects?

Prof Levin: Early in my scientific life reading the "Anatomy of Body Water" (and Electrolytes by I.S. Edelman and J. Liebman, American Journal of Medicine (1959), and later "A Theoretical Definition of Minimal Acceptable Dialysis Therapy" by F. Gotch and J.A. Sargent, Kidney International Suppl., June (1978).

Prof Zoccali: The way scientific information is evaluated and communicated is changing rapidly. Which is for you the most challenging aspect of Science in the Internet era?

Prof Levin: My inability to read enough about what I am supposed to do while being fascinated by areas quite foreign to my work.

Prof Zoccali: Which is your favorite hobby?