Acknowledging the Challenges Faced by Trainees Building Careers in Kidney Research

The start of a new year often signals a time for reflection. As we move through 2022, we again may find ourselves asking: What is the state of nephrology research? How are trainees fairing as they build their own independent careers in this field? There are many sources of support that assist trainees at all levels as they hone the skills necessary for scientific investigation. However, this career path is not without challenges, including, but not limited to, scientific investigation funding, time that is dedicated for investigation, support to build a professional network, and the current lack of diversity in academia.

Although strong fiscal support for trainees exists in nephrology, there are stark realities that those pursuing a long-term career in kidney research face. At the societal level, ASN provides approximately $3 million annually to fund young researchers, fellows, and educators in nephrology through KidneyCure (1). The American Society of Clinical Oncology awarded over $9 million in 2020 for research support (2), and the American College of Rheumatology will be committing nearly $13 million to fund awards in fiscal year (FY) 2022 (3). Funding for kidney research also exists at the national level. The total estimated investment in kidney disease for FY 2022 by the US National Institutes of Health (NIH) is approximately $685 million. Although this estimate continues a trend of increased funding for nephrology research (4, 5), the amount pales in comparison to the estimated FY 2022 funding supplied by NIH toward other research areas, such as cancer ($7.4 billion), lung research ($2.3 billion), and heart disease ($1.6 billion) (Figure 1) (5). The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has also disbursed many fellowship, career development, and training awards over a 10-year span (6). Recently, NIDDK reshaped its T32 programs to propel kidney, urologic, and hematologic training and research through its U2C/TL1 Institutional Network Awards (7). This program will eliminate divisional single-discipline T32 awards and instead prioritize funding awards that span multiple institutions and disciplines (for example, hematology, urology, and nephrology). It is currently unclear how this shift will ultimately impact the long-term funding opportunities available to those investigating kidney function, health, and disease.

Estimates of funding for various research, condition, and disease categories for FY 2022

Citation: Kidney News 14, 4

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Estimates of funding for various research, condition, and disease categories for FY 2022

Citation: Kidney News 14, 4

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Estimates of funding for various research, condition, and disease categories for FY 2022

Citation: Kidney News 14, 4

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Opportunities for investigation are also critical to scientists’ growth at all levels. Finding time for research can be difficult, as trainees are often pulled in many directions. Clinical demands, teaching workloads, and other institutional requirements can compete with (and at worst, derail) trainees’ plans for novel scientific investigation. It is important for mentors, program directors, departments, and institutions to provide trainees and young investigators with opportunities to spend time performing experiments and writing manuscripts and grant applications. These tasks are essential components for budding scientists as they work toward independence.

Avenues through which scientists at different career stages can share their research and participate in networking opportunities are important. ASN provides several opportunities for this, first and foremost through ASN's Kidney Week, the premier meeting for nephrologists and kidney researchers. ASN's partnership with another prominent scientific organization, the American Physiological Society (APS), has led to the creation of the Basic Research Forum for Emerging Kidney Scientists. This Kidney Week pre-meeting is an early-career event that allows nephrology trainees and early-career investigators of diverse backgrounds a platform to share their basic science research with experts in their field. This event also creates opportunities for small-group networking and career development through panel-based talks or mock study sections. The triennial APS/ASN Control of Renal Function in Health and Disease conference, occurring this summer, is another example of a venue that provides basic researchers the opportunity to present their work in a public platform.

All of these factors provide a foundation for career development and advancement, but it is important to understand that support is multi-faceted. Support also involves opportunities to increase inclusion for groups underrepresented in medicine (URiM). According to the National Science Foundation, people who are URiM made up a small percentage of the 6008 US citizens and permanent residents who received a doctorate in biological and biomedical sciences in 2020: individuals who are Black or African American, 265 (4.4%); Hispanic or Latino, 521 (8.7%); and American Indian or Alaska Native, 9 (0.2%) (8). Although the percentage of individuals in URiM groups with academic doctoral positions has increased over the past 20 years, some percentages remain considerably small as of 2019, with 8.9% of URiM individuals holding doctoral positions (9).

Training a diverse workforce is critical for innovation and growth. Recognizing the need for this, ASN has created the Loan Mitigation Pilot Program (LMPP), which will focus on URiM groups in the first year. Although more needs to be done across the field to promote and sustain the inclusion of people from different backgrounds, the LMPP is an effort to increase diversity of the nephrology workforce to match the patient population (10). Similarly, loan-mitigation awards for those interested in pursuing research as part of their long-term careers may facilitate the growth of a diverse research environment in nephrology.

The path to creating and sustaining a career as an independent investigator in kidney research is not always a straightforward journey, and a gauntlet of challenges exists along the way. There are strong sources of support that exist already at the societal and national levels, but increased institutional intervention can complement these opportunities to enhance the experiences of trainees as they progress in their training. Our passion and will to make the communities around us a reflection of our continued optimism allow us—researchers and clinicians—to be hopeful for our future careers and for the field of nephrology as a whole.

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