Perspectives from a Junior Investigator in the Kidney Precision Medicine Project

Laura H. Mariani

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“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 to their own institutions to recruit patients with either chronic kidney disease or acute kidney injury for a kidney biopsy to be used for research. But as the recruitment sites were assembled and became a single KPMP research team, the protocols were harmonized and transformed to a shared approach, accommodating differences in institutions and patient populations along with the needs of the tissue interrogation sites.

I learned the true value of multidisciplinary perspectives to accomplish this task and other tasks of a large consortium. The products are made infinitely better by the inclusion of perspectives from patients, clinicians, study coordinators, clinician and basic scientists, programmers, biostatisticians, ethicists, and, perhaps most important, project managers to keep everyone on task.

And then, to be able to participate in translating a protocol into the nuts-and-bolts tools necessary to launch a multisite study is the sort of invaluable training experience provided to KPMP junior investigators. There is no better way to really understand a study than to help write the manual of procedures, draft questions on case report forms, sit with a programmer building the data collection system, or train a study coordinator. This process of iterative improvement, listening to unique perspectives, and creativity to address barriers and compromise applies to scientific tasks well beyond protocol development to study execution, data generation, interpretation, and communication.

These tangible training experiences occur simultaneously with the intangible experiences. Principally, the consortium expands the pool of mentors and collaborators just by the number and diversity of the KPMP scientific team.

KPMP supports a travel award program for trainees and junior faculty to attend the in-person investigators’ meetings and bring their work to a poster session. As junior investigators, we often work on projects in very small groups at our home institutions. To be able to discuss not only individual projects but also ideas, hypotheses, data sources, and approaches with investigators beyond our home institutions is instrumental in expanding our scientific training and resources. This exchange happens at the poster sessions and also in the main meeting and during working group calls in between. To listen to scientists with different approaches and training share data and ideas, but also, and perhaps more valuably, critiques, limitations, and suggested alternatives truly broadens my tools and scientific knowledge. Not unlike pursuing clinical training in more than one institution wherein you learn that there are multiple ways to practice high-quality clinical medicine, KPMP fosters a community of mentors and trainees who teach one another the value and limitations of a much-expanded number of approaches.

The fundamental overarching benefit of being a junior investigator in KPMP is the pursuit of a beautiful dream: to leverage the explosion of high-dimensional data generation, tissue image analysis, machine learning, and bioinformatics analyses to answer fundamental questions about some of the most common kidney conditions: diabetic and hypertensive CKD and AKI. Not only do we describe these conditions and their presentations but we build a resource based on human tissue, which can be used by the entire nephrology community to transform our clinical practice and allow us to answer the most basic questions asked by our patients: 1) What disease do I have? 2) What will happen to me? And 3) What can you do about it?

The KPMP embraces this goal by committing to truly open science by building the kidney tissue atlas, which will make the data, so generously provided by participants, readily available and accessible to researchers outside of KPMP and also to patients and clinicians to tackle these fundamental questions.

When I read the personal statements of nephrology fellowship applicants, I am reminded of the enthusiasm that nephrology can inspire as applicants describe their satisfaction in grasping renal physiology, the devastation at watching kidney failure in their patients, and their awe of the importance of the healthy kidney to other organ systems. KPMP captures that enthusiasm by bringing together investigators who want to tackle big questions by working collaboratively and openly. That enthusiasm is infectious.

It is easy to believe in the big dream that the conversations I have with my patients now will be vastly different in the future as we discuss the best medication, out of many choices, to protect their kidneys from injury, speed recovery, and prevent progression to kidney failure.

March 2019 (Vol. 11, Number 3)