After a sustained effort in support of National Institutes of Health (NIH) funding by the American Society of Nephrology (ASN) and the broader kidney community, Congress passed a $2 billion funding increase for NIH for fiscal year (FY) 2019. Additionally, the National Institute of Diabetes and Digestive Kidney Diseases (NIDDK) received a 5% increase that was widely celebrated by the kidney community.
Unfortunately, the gains seen by NIH and NIDDK have not translated into funding for the Division of Kidney, Urologic, & Hematologic Diseases (KUH), which saw a 2% decrease in total funding. NIDDK is a payline-driven funding program that “follows the science,” meaning that Divisions that receive more applications receive more funding and are, therefore, able to provide more awards. So, while NIDDK has continued to see its budget increase due to congressional appropriations, the allocations to KUH have lagged when compared to other NIDDK Divisions.
A central portion of the NIDDK portfolio are R01s, which contributed to 93% of the NIDDK increase in total awarded dollars from 2017 to 2018. Despite its significance to the overall NIDDK portfolio, KUH has seen a slow erosion of its R01s over the years and experienced an 8.7% decrease in R01 applications from 2018 to 2019. More troubling is that this trend will continue to grow unless there is a significant increase of early stage investigators (ESI) applying for funding; however, KUH saw ESI applications fall a staggering 27% in only one year—2018 to 2019.
Compounding the problem is the fact that the kidney community is losing the battle on two fronts. Not only are the total number of KUH applications stagnant compared to the rest of NIDDK, but the applications are historically awarded less funding. The average total cost of NIDDK competing R01 awards in 2018 was $484,019, while the average in KUH was $461,000. ASN leadership strongly encourages every investigator applying for funding to explicitly ask for what their study needs and to justify those numbers.
“Kidney patients are desperately waiting in our dialysis clinics, hospitals, and offices for new therapies. It is solely up to us now, as a community, to generate hope that reaches from patients and their families to potential future nephrologists by prioritizing existing and emerging programs that bolster cutting-edge investigative activities and attract the best minds to the nephrology specialty. ASN has initiated several programs with this goal in mind and will continue to identify new opportunities with the goal of stemming this tide,” Crystal A. Gadegbeku, MD, FASN, ASN Policy and Advocacy Committee Chair, said in a recent statement.
ASN has launched several initiatives to foster interest in careers in nephrology and research and to advance the careers of those who have already entered the nephrology workforce including:
■ Kidney STARS (Students and Residents) provides complementary membership to the society, $1000 in travel support, and complementary registration to attend the ASN Annual Meeting at Kidney Week, in Washington, DC, and tailored events and networking opportunities onsite.
■ Kidney TREKS (Tutored Research and Education for Kidney Scholars) seeks to accomplish the same goal through a weeklong research course retreat and long-term mentorship program.
■ KidneyX, a new public-private partnership between ASN and the U.S. Department of Health and Human Services (HHS), aims to accelerate breakthroughs to promising new technologies for people with kidney diseases and tangentially spur interest in nephrology by positioning it as an exciting and growing field.
■ ASN Foundation for Kidney Research Career Development Grants Program provides funding for young faculty to foster evolution to an independent research career and a successful application for a National Institutes of Health (NIH) full R01 grant or equivalent. By the end of the grant period, a recipient will have an independent research career and be competitive for federal and nonfederal funding.
Similarly, NIDDK has several programs geared toward fostering the next generation of kidney investigators with the goal of ensuring they become an independent researcher:
■ NIH Summer Internship Program in Biomedical Research (SIP) provides a developmental training experience to promising high school, undergraduate, and graduate students who have expressed a strong interest in or are studying disciplines related to biomedical sciences.
■ Postbaccalaureate Intramural Research Training program provides recent college graduates who are planning to apply to graduate or professional school an opportunity to spend one or two years performing full-time research at the NIH.
■ Undergraduate Scholarship Program offers competitive scholarships to students from disadvantaged backgrounds who are committed to careers in biomedical, behavioral, and social science health-related research. The program offers paid research training at the NIH during the summer and paid employment and training at the NIH after graduation.
■ Predoctoral to Postdoctoral Fellow Transition Award seeks to recruit exceptional graduate students who are recognized by their institutions for their high potential and to incentivize them to pursue a Kidney, Urologic or Hematologic postdoctoral position.
ASN encourages its members to share both its and NIDDK’s unique opportunities with potential researchers who are interested and eligible. The society will continue to advocate for increases to the NIH and NIDDK budgets. By being united and fighting this battle on multiple fronts, we can make certain that any budget increase NIDDK receives from congressional appropriations is reflected in a proportional increase to KUH. ASN will keep readers apprised of future developments.