American Society of Nephrology Renal Research Report.

In the spring of 2004, the Board of Advisors and the Council of the American Society of Nephrology believed it necessary to conduct a series of research retreats to steer priorities appropriately in an era of limited resources. In this regard, retreats were conducted by five working groups in areas that were identified to require distinct attention: acute renal failure, diabetic nephropathy, hypertension, transplantation, and uremic cardiovascular toxicity. The goal of each retreat was to join experts, both within and outside the renal community, to identify areas of basic science and clinical research that should receive highest priority in the next five years. The five retreat summaries with their individual listings of research priorities allow for the distillation of three overriding recommendations that strongly emanate from them: Continued support and expansion of investigator initiated research projects. In each of the five subjects on which this report is focused, there are areas of investigation that require the support of investigator-initiated projects if ultimately progress is to be made in the understanding of the basic mechanisms that underlie the diseases processes on which we want to have an impact in the next decade. It is recommended that there be an expansion of support for research in the areas highlighted in this report that lend themselves to this mechanism of funding by encouraging applications with appropriate program announcements and requests for proposals. In addition to vigorous support for RO1 grants, continued funding of Concept Development and R21/R33 grants is essential to support development of investigator-initiated clinical studies in these areas of high priority. Support for the development of a collaborative research infrastructure. The reader of this article cannot but be impressed by the common theme that independently emerged from each report regarding the urgent need to develop an infrastructure for kidney research. This infrastructure requires the development of core facilities for the centralized processing of biologic materials (genomics, proteomics, and metabolomics), in vivo imaging, development and distribution of antibodies and other molecular reagents, development and distribution and phenotyping of mouse models, and perhaps others. These need to be complemented with core bioinformatics centers that collect and analyze data and finally with a network of clinical study coordinating centers. Expansion of kidney research infrastructure can be achieved by vigorous funding of a program of kidney research core centers. Specifically, we propose that the number of kidney centers be increased with the goal of providing core facilities to support collaborative research on a local, regional, and national level. It should be emphasized that such a program of competitively reviewed kidney core centers would facilitate investigator-initiated research in both laboratory and patient-oriented investigation. This approach is also very much in line with the collaborative research enterprise conceived in the National Institutes of Health's Road Map. Support programs that have an impact on the understanding of the relationship between renal and cardiovascular disease (CVD). It is now widely recognized that chronic kidney dysfunction is an important risk factor for the development of CVD. It therefore is not surprising that essentially every one of the retreat reports emphasizes the urgency to examine this relationship. It is recommended that the National Institute of Diabetes and Digestive and Kidney Diseases and the National Heart, Lung, and Blood Institute (NHLBI) work cooperatively to support both basic and clinical science projects that will shed light on the pathogenesis of this relationship and to support the exploration of interventions that can decrease cardiovascular events in patients with chronic kidney disease. Thus, we specifically propose that the NHLBI support investigator-initiated research (RO1, Concept Development, and R21/R33) grants in areas of kidney research with a direct relationship to CVD. Similarly, the NHLBI should work collaboratively with the National Institute of Diabetes and Digestive and Kidney Diseases to support the proposed program of kidney core research centers. This subject provides an excellent opportunity to foment a collaboration between two institutes, along the lines of the present-day overall philosophy of the National Institutes of Health.