He is climbing 41 alpine summits to collect money for his research. Tuğrul Irmak is adamant that the artificial kidney will come. “It’s my own ass on the line.”
Tuğrul Irmak in his own armchair, with a climbing axe to his left - needed for his alpine treks. (Photo: Thijs van Reeuwijk)
The mountain climber is briefly back in the Netherlands again. His last climb had to be aborted three quarters of the way up, due to bad weather and exhaustion. But it may just be the case that as you read this, Tuğrul Irmak is once again planting a flag at the top of a mountain. Forty-one summits in five months. If he wants to achieve this goal, he should not stay too long in the flat Netherlands.
Irmak wants to use his adventure to collect money for research. Research on himself that is. The TU Delft and UMC Utrecht researcher is working with his colleagues on an artificial kidney. Irmak’s dream? A biomedical device in the body that avoids kidney patients being dependent on dialysis.
Climb Against Time
Tuğrul Irmak headed to the Alps on 15 May for his Climb Against Time challenge. He hopes to climb 41 summits between then and 15 October. Other people have joined him on some of the ascents. Furthermore, Irmak challenges everyone to do their own challenge – climbing, bouldering, running, walking, whatever it may be.
The goal of Climb Against Time is to collect money for research on artificial kidneys. Irmak is receiving financial support from the Friends of UMC Utrecht Foundation and the Wilhelmina Children’s Hospital. Make a donation online (in Dutch).
Irmak knows all too well how unpleasant dialysis is. His kidneys started to fail in 2019 and in September 2022 he became dependent on dialysis. It was his mother’s donated kidney that saved his life in May 2023. She birthed him for the second time, Irmak says poetically.
But when asked to introduce himself, Irmak starts with other aspects. “First and foremost, I’m a mechanical engineer. And I’m a climber.” And then hesitatingly, “And someone that is struggling with a chronic condition, I guess.”
The third aspect comes across a lot less convincingly.
“I can’t deny that it’s a part of who I am. You don’t choose to have a disease. You don’t want your identity to be governed entirely by something that you can’t control. But it is there and it is part of me.”
Tuğrul Irmak is now living in Delft, but was born in Istanbul in 1994 and moved to Essex in the United Kingdom when he was seven years old. When he was 11, a simple children’s illness led to IgA nephropathy, a chronic autoimmune disease. The disease is like Russian roulette: half the patients can live quite normally with it, but the other half suffer kidney failure within 20 years.
What is it like to live with that uncertainty?
“I always realised that my time may be limited. I might therefore have felt that I had to do a lot, because I didn’t know how many healthy years I had left. So I always kept pushing on – that becomes habit.”
When he was a child Irmak wanted to be an astronaut. “I remember bouncing up and down like I was Buzz Aldrin during the lunar landing. But with my disease I could never have become one.”
So he turned to plan B: mechanical engineering. He left Great Britain in 2018 and moved to Delft for a doctoral programme. His subject was self-driving cars. To be more precise, it was the neuroscience side of this – Irmak earned his doctorate on motion sickness.
But in 2019 his kidney function seriously declined. He was one of the people whose kidneys stopped working because of IgA nephropathy. He remembers how he told his colleagues at TU Delft the news. “I said, I’m not doing so well, so you’re going to see a decrease in my output. Of course, everyone was very understanding. But you don’t want to dwell on it all the time, right?”
You got sicker but hardly talked about it, Alberto, your colleague and friend, said. He only saw how vulnerable you were when he unexpectedly turned up at your house one day. Were you afraid of being seen as weak?
“I wasn’t in bed, you know. I was still working and physically strong. So I wasn’t that worried that I would be seen as weak. Maybe it was the opposite. Everyone knows you’re sick, but at the same time you’re out climbing rock faces at the weekend.”
Irmak was already a mountaineer, but from then on he took it even more seriously. He drove to the Alps more often to climb the mountains there.
Other people would perhaps think that they should take it easy. But you went to the mountains even more often.
“I wanted to prove I could do it, that I wasn’t actually ill. I not only get joy from climbing, but also some sort of meaning. A day in the high Alps does a lot more to me than a month in the Netherlands. It simply creates a lot more memories.”
Was it also fatalism that pushed you to the mountains?
“To some degree, but it’s not a dominating thought. It’s more a case of thinking that I only had a few healthy years left, so I might as well make the most of them.”
In September 2022 this became the reality. “My kidneys only worked 30% by then. I immediately had to go on dialysis.”
The dialysis could at least be done at home through a unit next to his bed. Irmak attached himself to it every night for months. “I felt like an organism instead of a human being. You want to drink, but you can’t because you can’t pee. You don’t feel good because you can’t get rid of your waste. And always that fear: how can you still be human if a machine is keeping you alive?”
Irmak got through those hours in bed attached to tubes with a pile of textbooks next to him. The idea of further delving into the neuroscientific side of his career had emerged far earlier. He had started taking master classes on biomedical sciences in 2019 without having a clear goal in mind. Till now.
‘You feel worse and worse. Dialysis is purely survival’
What changed?
“My drive changed. Dialysis doesn’t solve all problems. It takes over 15% of your kidney function at the most. Some proteins cannot be filtered, and the toxins attached to them cannot be cleared. After a while that leads to cardiovascular disease, cognitive decline, fertility issues, joint mobility issues. You feel worse and worse. It is purely survival. I realised that I didn’t want to go through that again. I also realised that, as a scientist, I was able to take matters into my own hands.”
Why is that such an important difference?
“There are many initiatives trying to improving dialyses, but not many are devoted to actually ending it. An example would be the wearable dialysis system that’s being worked on. This sounds like a great idea. You can walk around and you get filtration all day long.
But isn’t it better to just connect to the machine at night at home? That’s a lot better than people looking at you really weirdly with all this extra baggage hanging around. I know from experience that it’s not worth the effort. That’s not going to improve people’s lives.”
While he was building his career, Irmak was on the waiting list for a transplant. It was already clear that he would get one of his mother’s kidneys, but it took another ten months before the hospital had place for the double operation. It was done in May 2023 and after a bumpy start, Irmak started feeling better quickly. Only three weeks after the surgery he started his new job at UMC Utrecht, working on the desired artificial kidney.
What will it look like?
“The idea is that our artificial kidney can be implanted inside the body. It will be a device with both technical and biological elements. It simply must just work once it’s in the body – you shouldn’t have to think about it anymore. It should cooperate well with all the processes in the body.
The artificial kidney will consist of two parts. First, a filter that purifies the blood from harmful substances, and second, a component with living kidney cells that helps the body reabsorb useful substances. We’re currently focusing on the filter, and one of the challenges is that the membrane that does and does not allow certain substances to pass through, doesn’t get clogged with certain proteins that cannot go through. We’re looking into how we can basically tailor the coating such that fouling happens less over time, so we maintain the filtration capacity of the device for as long as possible.
Our first goal is an implantable dialyser, making it possible to dialyse without needles, inside the body. For that, we need a filter that lasts a long time, ideally over the span of let’s say three years. We hope to have a prototype of that filter by the end of this year.
This implant should act as a bridge towards transplantation, so people don’t have to rely on dialysis in the meantime. The next step after that is the full artificial kidney.”
You mostly work at the UMC Utrecht. What do you do at TU Delft?
“I study possible coatings for the artificial kidney that needs to work with blood. But blood does not like foreign substances, and it has a clotting response against them. If a clot forms, it can block the artificial kidney, or worse, it can travel up to the lung or the brain, which could be fatal. We want to prevent that. That’s why, together with my colleagues and students, I’m looking at polyelectrolytes for anti-fouling and antithrombotic properties.”
‘It’s a fact that I wasn’t working on the artificial kidney until my own ass was on the line’
Are you doing your research to save your own life or for the greater good?
“I can’t disentangle the two. It’s a fact that I wasn’t working on this until my own ass was on the line. And only when I started reading about it, did I realise how stagnant this field is. Dialysis was invented in 1943, but has barely improved since then. I feel like it’s my social responsibility to change that, and of course that is intertwined with my personal motivation.”
Do you have faith that the artificial kidney will turn up?
“No. You can never be confident that your highly ambitious engineering goal will succeed. But I have skin in the game, so I kind of have to believe in it. So let’s say I’m optimistic. There are already examples, like artificial hearts. That shows it can be done. So I think artificial kidneys can become real as well, with enough effort and ambition.”
You climb mountains to collect money for the artificial kidney. You did not need to do this for the self-driving cars that you initially worked on. Does that hurt?
“What stings the most is that very little money is put into fundamental change when it comes to kidney failure. I think the reason is that people basically see the solution in dialysis. Despite the side effects you won’t die, that’s what people thinking when it comes to dialysis. There’s no felt need to change it – at the most, to make dialysis better – while dialysis actually costs society a lot of money.
With self-driving cars, a lot of money is poured by the industry into what is essentially luxury goods. These are part of a package of the future, a utopia kind of thing, something green, cool and positive. That appeals to people. But if you talk about ending dialysis, there’s not that positive appeal that applies to everybody. It only attracts the patients and their loved ones.”
How are you doing now health-wise?
“I recently had a checkup and it was pretty good. I am confident that it will stay that way. A live donor transplant has an average life expectancy of 15 to 20 years. At the moment there’s no reason to suspect it will be any less. But if it fails, I would have to go on dialysis again. At that point, I want our research to be at the test stage. If that happens, I’ll be the first one to try it.”
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