The Kidney Precision Medicine Project (KPMP) is a transformative initiative funded by the National Institute of Diabetes and Digestive and Kidney Diseases. It is designed to tackle the major public health burdens resulting from acute kidney injury (AKI) and chronic kidney disease (CKD). The rationale for KPMP is straightforward: Despite the significant impact of AKI and CKD on patient outcomes, no proven safe and effective therapies exist for AKI, and only a few are available for CKD.
The landscape of treatment for these kidney disease syndromes has not changed substantially in many years, and we have a poor
Patient-reported outcomes (PROs), or measures elicited directly from patients, can provide insights into patients’ well-being that cannot be captured by laboratory values. PROs, which can include measures of physical symptoms, emotional health, and treatment preferences, have been shown to enhance shared decision-making between physicians and patients, enhance workflow efficiency when used regularly, and allow for more nuanced predictions of disease trajectory (1–3). The US Food and Drug Administration and the Standard Protocol Items: Recommendations for Interventional Trials PRO extension have each emphasized the need to include PROs as clinical trial endpoints, and kidney patients have prioritized
Roman Reindl-Schwaighofer, Andreas Heinzel, and Rainer Oberbauer
Kidney transplantation is the prototypical example of the routine practice of personalized/individualized therapy. To optimize individual outcomes, donors and recipients are matched on the basis of their HLA genotypes, and histocompatibility is further tested in vitro. The mandatory medical immunosuppression therapy is adjusted based on the results of these tests and the clinical course.
Because full HLA matching occurs only in homozygous twins, and recognizable antigens differ between HLA type mismatches, in silico tools for epitope matching such as the PIRCHE score or the HLAMatchmaker may facilitate a refined risk stratification of the alloresponse (1).
“The future belongs to those who believe in the beauty of their dreams.”
— Eleanor Roosevelt
Working with the Kidney Precision Medicine Project (KPMP) consortium as a junior investigator is a tremendous opportunity for me, with tangible training experiences and many more intangible moments for professional growth and creativity.
Certainly, the tangible training experiences are exceptional, and the KPMP consortium has not only allowed, but encouraged, contributions from junior investigators, allowing us to learn best by doing. In particular, each research team from a recruitment site interpreted the request for application independently and proposed an approach relevant
Approximately 415 million adults worldwide had diabetes mellitus (DM) in 2015, and even though over 650 billion USD were allocated for treatment, about 5 million individuals died. The impact of DM will continue to grow because the prevalence is expected to increase by more than 50% within the next 30 years (1). The rise in prevalence of diabetes will be accompanied by a significant rise in DM-associated complications such as diabetic kidney disease (DKD) (2).
Two aspects of glomerular function, urinary albumin excretion and estimated GFR (eGFR), are used in clinical practice for defining stages of
Many areas of medicine have seen great leaps in innovative therapies in recent years, but treatment for kidney disease has scarcely changed since the introduction of dialysis some 60 years ago.
ASN’s Kidney Health Initiative responded to this perceived lag by pushing toward a new treatment paradigm in its “Technology Roadmap for Innovative Approaches to Renal Replacement Therapy.”
“This roadmap identifies challenges and opportunities and encourages diversity of thought and attraction of expertise from various scientific and engineering communities,” according to Joseph V. Bonventre, MD, PhD, of Brigham and Women’s Hospital and Harvard Medical School in Boston. Bonventre led a
Asia, home to 60% of the world’s population, is a unique showcase of geographic, racial, and ethnic diversity that has potential implications for disease diagnosis and management. Use of serum creatinine–based estimated GFR (eGFR) equations for diagnosis and staging of chronic kidney disease (CKD) is a perfect example that exemplifies these challenges.
Kidney Disease Improving Global Outcomes (KDIGO) currently recommends Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation (CKD-EPICr) for diagnosis and staging of CKD, but encourages use of a validated equation in the local population, if available.
Dietary protein intake and muscle mass, key determinants of steady state serum
As I considered possible developments in nephrology for this coming year, I could not help but think a bit further forward to the year 2020. This led me to think more about the Centers for Disease Control and Prevention’s Healthy People 2020 initiative (1), the national blueprint designed to bring about effective preventive care and improved health to the U.S. population by 2020. This ongoing initiative started decades ago, issuing 10-year plans and starting with general interventions such as ensuring a clean environment, drinkable water, good nutrition, increased exercise, and access to high-quality healthcare. The plan then moved
Look for shake-ups in the business of health in 2019. Insurers, providers, and other business interests are working together to fundamentally change the way healthcare is delivered.
We can only guess what changes may lie ahead, given the combination of Aetna and CVS. Amazon’s acquisition of PillPack likely signals some sort of “Prime Drug” service in the future. We also need to keep an eye on their healthcare venture with Berkshire Hathaway. Industry insiders suggest they have an eye toward mining patient data for new insights and efficiencies.
Mergers and acquisitions no longer occur just among companies producing the same
The gut microbiome is believed to have evolved with time and exists in symbiosis with the system in the healthy state because of its synthetic, metabolic, and immune properties. Recent studies have hypothesized that specific microbial metabolites, particularly short-chain fatty acids and D-amino acids (D-AAs), are important contributors to the maintenance of health. Disturbance of this relationship, known as dysbiosis, has been implicated in various diseases.
The emerging literature on the metabolic potential of gut microflora and its integral role in the pathogenesis of inflammatory conditions is attracting increasing interest from the nephrology community in further exploration of the gut–renal