American Society of Nephrology Renal Research Report
Abstract
In the spring of 2004, the Board of Advisors and the Councilof the American Society of Nephrology believed it necessaryto conduct a series of research retreats to steer prioritiesappropriately in an era of limited resources. In this regard,retreats were conducted by five working groups in areas thatwere identified to require distinct attention: acute renal failure,diabetic nephropathy, hypertension, transplantation, and uremiccardiovascular toxicity. The goal of each retreat was to joinexperts, both within and outside the renal community, to identifyareas of basic science and clinical research that should receivehighest priority in the next five years. The five retreat summarieswith their individual listings of research priorities allowfor the distillation of three overriding recommendations thatstrongly emanate from them:
Continued support and expansionof investigator initiated researchprojects. In each of thefive subjects on which this reportis focused, there are areasof investigation that require thesupport of investigator-initiatedprojects if ultimately progressis to be made in the understandingof the basic mechanisms thatunderlie the diseases processeson which we want to have animpact in the next decade. It isrecommended that there be anexpansion of support for researchin the areas highlighted inthis report that lend themselvesto this mechanism of fundingby encouraging applications withappropriate program announcementsand requests for proposals.In addition to vigorous supportfor RO1 grants, continued fundingof Concept Development andR21/R33 grants is essential to supportdevelopment of investigator-initiatedclinical studies in theseareas of high priority.
Support for the development of a collaborativeresearch infrastructure.The reader of this article cannot butbe impressed by the commontheme that independently emergedfrom each report regardingthe urgent need to develop an infrastructurefor kidney research.This infrastructure requires the developmentof core facilitiesfor the centralized processing of biologicmaterials (genomics,proteomics, and metabolomics), in vivoimaging, developmentand distribution of antibodies and othermolecular reagents,development and distribution and phenotypingof mouse models,and perhaps others. These need to be complementedwith corebioinformatics centers that collect and analyze dataand finallywith a network of clinical study coordinating centers.Expansionof kidney research infrastructure can be achievedby vigorousfunding of a program of kidney research core centers.Specifically,we propose that the number of kidney centers beincreased withthe goal of providing core facilities to supportcollaborativeresearch on a local, regional, and national level.It shouldbe emphasized that such a program of competitivelyreviewedkidney core centers would facilitate investigator-initiatedresearch in both laboratory and patient-oriented investigation.This approach is also very much in line with the collaborativeresearch enterprise conceived in the National Institutes ofHealth’s Road Map.
Support programs that have an impacton the understanding ofthe relationship between renal and cardiovasculardisease (CVD).It is now widely recognized that chronic kidneydysfunctionis an important risk factor for the developmentof CVD. It thereforeis not surprising that essentially everyone of the retreatreports emphasizes the urgency to examinethis relationship.It is recommended that the National Instituteof Diabetes andDigestive and Kidney Diseases and the NationalHeart, Lung,and Blood Institute (NHLBI) work cooperativelyto support bothbasic and clinical science projects that willshed light onthe pathogenesis of this relationship and to supportthe explorationof interventions that can decrease cardiovascularevents inpatients with chronic kidney disease. Thus, we specificallypropose that the NHLBI support investigator-initiated research(RO1, Concept Development, and R21/R33) grants in areas of kidneyresearch with a direct relationship to CVD. Similarly, the NHLBIshould work collaboratively with the National Institute of Diabetesand Digestive and Kidney Diseases to support the proposed programof kidney core research centers. This subject provides an excellentopportunity to foment a collaboration between two institutes,along the lines of the present-day overall philosophy of theNational Institutes of Health.
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