Research in the CKD Clinic: Highs and Lows

Abstract

Despite rates of chronic kidney disease (CKD) continuing to increase, the current evidence base used to guide CKD management is smaller than that for many other chronic diseases. Clinical investigators face multiple barriers to conducting research in patients with CKD. CKD patients have multiple comorbidities making them a risky intervention target and are often excluded from trials as a result. The lack of approved surrogate endpoints for kidney disease progression makes testing therapies to slow progression very challenging and expensive. Patients with CKD have higher rates of disability and lower educational status than the general population which further complicates their participation in clinical trials. In spite of these barriers, it is imperative that scientific progress be made in this patient population. Increasing education and information regarding CKD clinical trials through brochures and public awareness campaigns may increase trial participation. The FDA needs to approve the new definition of GFR decline as this will result in a decrease in the cost of clinical trials and make industry more likely to invest in trials in patients with CKD. Successful research in this patient population is possible but it requires collaboration between investigators, healthcare providers, patients, industry and the NIH.

A Digital Modality Decision Program for Patients With Advanced Chronic Kidney Disease

“…Enrolling patients with CKD into clinical trials is challenging. Reasons for low enrollment of CKD patients into clinical trials may include their high comorbidity burden, necessitating frequent doctor visits or hospitalizations that make the patient unable to attend study visits, and their high rates of disability [30]. We observed that out of over 2000 screened patients, 98 were eligible for the study after the phone interview.…”

Self-management of dietary intake using mindful eating to improve dietary intake for individuals with early stage chronic kidney disease

“…Once participants started the intervention both the attendance (average number of sessions attended 5.6 out of 6) and retention (90.5%) were high, demonstrating a strong commitment to the study in a diverse group of primarily men with multiple challenging health conditions. Individuals with CKD are identified as facing multiple barriers to clinical trial participation (Decker & Kendrick, 2014). The retention and attendance along with the positive feedback in the exit interviews from this study indicates that this intervention has a high level of acceptability to participants.…”

Increased Arterial Stiffness after Coronary Artery Revascularization Correlates with Serious Coronary Artery Lesions and Poor Clinical Outcomes in Patients with Chronic Kidney Disease

“…Researchers have reached a consensus that the lack of approved surrogate endpoints for kidney disease progression makes testing therapies to slow progression very challenging and expensive in improving cardiovascular outcomes [23,24]. Weir and Townsend [25] share this opinion and found out vascular stiffness could be used as a surrogate measure of mortality in CKD patients.…”