 Jonas Bergström, one of the leading clinical scientists in nephrology and a Past President of the International Society for Peritoneal Dialysis (ISPD), died 17 August 2001. His scientific activity, which spans a period of almost 50 years, was focused on clinically important issues, with emphasis on pathophysiology and treatment of metabolic and nutritional abnormalities in renal failure patients on conservative treatment, hemodialysis (HD), and peritoneal dialysis (PD). He had a unique ability to combine advanced research methods, some of which he had to develop himself, with research issues of high importance for the daily care and treatment of patients with chronic renal failure (CRF). Despite suffering for more than 5 years from the illness of which he died, he remained an active and dedicated scientist to the very end. He published more than 600 scientific papers in clinical biochemistry, renal physiology, electrolyte metabolism, nutrition, and renal medicine and is one of the most cited clinical scientists in nephrology. Colleagues in Stockholm and other parts of the world are saddened at the loss of this scientist, physician, researcher, mentor, musician, and friend. Dr. Bergström was born in 1929, in the city of Luleå in northern Sweden, into a music-loving family. Music, and especially jazz, was a major interest in his life and he became one of the best jazz musicians in Sweden in the early 1950s. Although medicine soon became his first priority, he maintained his music skills throughout his life. During the ISPD meeting in Stockholm in 1995, he entertained his guests at the President’s dinner with a great performance, playing jazz clarinet with his musician friends. He also maintained his love for the nature, people, and simple life of northern Sweden, which he visited every summer.
Jonas Bergström studied medicine at the Karolinska Institutet in Stockholm, Sweden, and graduated as a medical doctor in 1956 following his decision to give up a career as a jazz musician. He trained in biochemistry and renal physiology from 1956 to 1962 as a junior associate in the chemistry laboratory of S:t Erik’s Hospital. From 1962, he served as resident at the Renal Clinic of S:t Erik’s Hospital, and in 1964 he became Associate Professor of Clinical Electrolyte Research at the Karolinska Institutet. In 1967 he became Senior Resident in Nephrology at S:t Erik’s Hospital, with special responsibility for the development of chronic dialysis. In 1969 he became the director of the Renal Clinic, which in 1980 moved to Huddinge University Hospital. From 1980 he served as Professor of Renal Medicine at the Karolinska Institutet, a position he held until his retirement in 1994. In January 1995, he became Senior Medical Consultant for Baxter’s Renal Division while being affiliated with the Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska Institutet, as Professor Emeritus. With this new role, he could focus even more than before on research in collaboration with an increasing number of young investigators from all over the world. He had already started his scientific career in 1954 as a junior research assistant with the cardiology group at S:t Erik’s Hospital in Stockholm, the group that pioneered cardiac catheterization in Sweden. His first paper (Studies on the Renal Circulation and Renal Function in Mitral Valvular Disease. I. Effect of Exercise. Werkö et al., Circulation 1954; 9:687) reflected an interest in physiology studies that would prevail throughout his career. His second and even stronger research line was clinical biochemistry, especially electrolyte metabolism and later, protein and amino acid metabolism. In 1959, he developed a method for percutaneous muscle biopsy, and in 1962 he published his thesis, Muscle Electrolytes in Man, which is still an often cited reference. Since then, the muscle biopsy technique has been used in many studies of muscle intracellular electrolytes, amino acids, proteins, and energy stores in humans, especially in studies of nutrition and metabolism in kidney disease, posttraumatic catabolism, and in sports medicine. In 1966, in a landmark study on muscle glycogen stores, Jonas Bergström and his colleague, Eric Hultman, performed repeat muscle biopsies on themselves while bicycling with one leg each after intake of different diets, with the nonbicycling leg serving as control. This much cited study resulted in the universally adopted high carbohydrate method used by athletes all over the world. When as a young doctor he started to work with nephrology at S:t Erik’s Hospital in 1962, he was challenged by the almost nonexistent possibilities of treating end-stage renal failure patients. This, and his studies on electrolyte metabolism in renal failure, elicited a passionate interest that would last his entire life, the study of metabolic abnormalities in uremia and uremia therapy. From then onwards, he dedicated his professional life to improving the situation for CRF patients. This resolve was further enhanced in 1964 by his training with Dr. Belding Scribner in Seattle, who convinced him that chronic dialysis therapy could help his patients. During the following 30 years, he spent a substantial amount of his time and efforts on finding the resources to build up the chronic dialysis program at the Department of Renal Medicine at S:t Erik’s Hospital, and from 1980 at Huddinge University Hospital. This was a most difficult task; resistance from politicians and health care administrators was tough, but in the end, he was always successful in the negotiations because he was not willing to give up any patient’s life for lack of resources. Due to his integrity and convincing argumentation (sometimes backed up by unconventional journalistic methods by his friends in the press), his adversaries usually granted his requests. In the 1960s and 1970s, dialysis resources were extremely limited, and this contributed to his interest in conservative uremia therapy and low protein diets. Supplements with essential amino acids, including histidine, such as Aminess (Recip AB, Årsta, Sweden), were developed and tested for their effects on nitrogen balance, extra- and intracellular amino acids, and uremic symptoms, which often could be improved for months or even years, thereby postponing the need for dialysis. During the 1970s, he became interested in uremic toxins, in particular middle molecules, and for several years and with the help of large grants from National Institutes of Health (NIH), U.S.A., a number of potential toxins were described. However, these studies were hampered by the lack of an accurate bioassay of uremic toxicity. It took almost 20 years to find such a bioassay, an experimental appetite model in rat, which is now used in Stockholm for assessment of one important aspect of uremic toxicity, namely anorexia. During his last years, he became more and more convinced of the importance of identifying what is toxic in uremia. From the 1970s he studied various aspects of HD, such as hemodynamics, blood pressure, and volume status. In 1976 he observed one day that a patient who usually suffered from hypotension during dialysis was symptom-free and reached her dry weight without problems, but because of a technical fault, no dialysis fluid was flowing through the dialyzer while ultrafiltration was taking place. This serendipitous observation resulted in the widely used technique of isolated ultrafiltration, or sequential ultrafiltration and dialysis. Other studies involved the hemodynamic effects of HD in healthy individuals, with Jonas Bergström participating as one of the research subjects. Peritoneal dialysis was already in use at S:t Erik’s Hospital in the 1950s, and the clinic was active in the development of systems and solutions for PD, including a PD machine with volumetric control of ultrafiltration. In 1978, he introduced continuous ambulatory peritoneal dialysis (CAPD) in Stockholm as one of the first units in Europe. This was followed by a range of studies on various aspects of CAPD, including prospective follow-up of nutritional status, metabolism of glucose, lipids, electrolytes, protein, and amino acids, as well as peritonitis. Nutritional studies included prospective follow-up of nitrogen balance in patients who were given their usual protein and energy intakes while undergoing metabolic studies in the hospital. The nitrogen balance studies resulted in a better understanding of the value of energy intake for nitrogen balance, as well as a new improved equation for the protein equivalent of nitrogen appearance (PNA) that is now widely used for estimating protein intake. Various alternative osmotic agents such as glycerol and amino acids were tested. These studies contributed along with others to the development of the amino acid-based Nutrineal (Baxter Healthcare, Deerfield, Illinois, U.S.A.) solution for CAPD patients. In addition, so-called dwell studies on peritoneal fluid and solute transport were initiated in the 1980s, using different dialysis solutions in different groups of patients, such as patients with loss of ultrafiltration capacity. In the 1990s, animal experimental studies using dwell studies in rats were introduced to test the effect of different solutions, osmotic agents, and additives on peritoneal transport. More recently, this research was extended to include structural alterations of the peritoneal membrane during PD. During the 1980s and 1990s, nutritional status and catabolic factors in CRF and dialysis patients was a major field of research. In one study, it was shown that the blood–membrane contact during HD resulted in protein catabolism. Nitrogen balance studies in CAPD patients demonstrated the importance of adequate protein and energy intake. Other studies analyzed the relationships between nutritional status, cardiac disease, and mortality. In 1995, he reported that high C-reactive protein, reflecting inflammation, was associated with poor nutritional status and poor survival in HD patients. This observation stimulated research on inflammation in CRF patients and provided the basis for the proposal of the malnutrition–inflammation–atherosclerosis (MIA) syndrome, which is associated with most premature deaths in end-stage renal disease patients. This is now a major research field not only in Stockholm but also in many other centers all over the world. During his last years, he was still very active in starting new projects while maintaining his interest in existing research lines. For example, he was convinced that the experimental appetite model in rat as (the only?) bioassay of uremic anorectic toxins should be a key priority, and he spent a substantial part of his last months on this project. On the other hand, he loved new and innovative ideas, such as genetic studies on CRF and its complications, a project that has just started. Jonas Bergström was a member of several international societies and was a council member of the The European Renal Association–European Dialysis and Transplant Association (two terms), the International Society of Nephrology, the International Society of Blood Purification (elected honorary member), and the International Society of Renal Nutrition and Metabolism. In the ISPD, he served as the President from 1992 to 1995. He was awarded the Alvarenga Prize for Medical Research in 1966, the Holger Crafoord Award in 1995, the International Capri Conference Uremia Award in 1986, the European Society of Parenteral and Enteral Nutrition Arwid Wretlind Lectureship Award in 1987, the Peritoneal Dialysis Award in 1998, and the Kidney Foundation International Medal in 1999. He was the President for the 5th Annual Meeting of the International Society of Blood Purification 1987, 7th International Conference on Renal Nutrition and Metabolism 1995, and the 7th Congress of the ISPD 1995. He served as a member of the Nobel Assembly of the Karolinska Institutet, the body that selects Nobel Prize winners in Physiology/Medicine, for 8 years (1986–1994). He gave numerous invited lectures on many different topics, including two plenary state-of-the-art talks on dialysis for the American Society of Nephrology. Jonas Bergström was very much appreciated as a teacher and lecturer because of his warm and modest personality, but especially because he had a thorough knowledge in many fields of the basic sciences, especially biochemistry and physiology, and in almost all parts of nephrology. When someone had a problem or a question, he would listen and then he could stun the listener (who could be a senior scientist or a student) by his easy display of knowledge, reminiscent of an open book. He had a complex and fascinating personality with many apparently contrasting traits. On the one hand, he was a bohemian who enjoyed the simple life (but also good wine and food), but he was also a very disciplined scientist and physician who paid great attention to details in research and patient care. He had a brilliant and analytical intellect, but was also a man with strong emotions. He could be a tough adversary, especially when defending the rights of his patients to get adequate treatment, but among friends, colleagues, and patients he was always an unpretentious, humorous, and very humanistic person. In his company, one was never bored; he was a very living person all his life. Many colleagues all over the world will miss him. However, the main residual feeling of most people he met will be a sense of gratefulness for having met this truly great person. For friends and colleagues in Stockholm and all over the world, Bengt Lindholm
Olof Heimbürger Divisions of Baxter Novum and Renal Medicine
Department of Clinical Science
Karolinska Institutet
Huddinge University Hospital
Stockholm, Sweden |