Kidney Precision Medicine Project: Hope for the Future

Jonathan Himmelfarb

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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 understanding of AKI and CKD heterogeneity between individuals. Thus, at present we are not close to the precision medicine goal of finding the right treatment at the right time for the right patient with CKD and AKI.

The KPMP is focused on finding new ways to treat AKI and CKD by safely and ethically obtaining and evaluating human kidney biopsy specimens from individuals who volunteer to participate. The kidney tissue will be analyzed in multiple ways, including intensive cutting-edge molecular analysis and the innovative use of digital histopathologic analysis coupled with machine-learning tools. This kidney tissue will be used to create a human kidney tissue atlas in health and disease as a publicly available resource for patients, caregivers, and researchers.

The KPMP focuses on people who have very common types of kidney disease for which we don’t really know the best treatment. With this focus, we can have the most impact in improving the outcomes for people everywhere living with kidney diseases. If we are successful, the KPMP will allow the entire kidney community to discover critical cells, pathways, and targets for novel therapies and to eventually devise individualized treatments based on these new insights. This is the essence of what kidney precision medicine is all about: bringing the right treatments at the right dose at the right time to the right patient with kidney disease.

There are several unique and exciting components to KPMP. One of the most important aspects of this project is that we’ve put patients at the forefront of our study. Patients are involved in all aspects of the study as equitable partners in KPMP. For example, our Community Engagement Committee is primarily made up of kidney disease patients who have helped develop our approach to informed consent and have provided multiple recommendations during protocol development. In addition to broad patient involvement, KPMP has a large and diverse group of stakeholders, each dedicated to the long-term success of the project. Also, KPMP is committed to fostering the development of junior investigator careers, including providing funding and travel awards for early-career investigators to attend our face-to-face meetings. We hope that KPMP contributes to fostering the next generation by strengthening the pipeline of researchers, clinicians, and educators.

On a personal level, it is both humbling and inspiring to be able to serve as part of the leadership for this historic project. For my entire professional life, I’ve taken care of patients with varying stages and types of kidney disease and have wished for more and better treatment options. I am hopeful that at the end of the day, this project will help us fully understand our patients’ medical conditions in ways that we often do not understand now, and completely change the way we care for our patients for the better.

March 2019 (Vol. 11, Number 3)