Translational nephrology: what translational research is and a bird's-eye view on translational research in nephrology

Abstract

The ultimate aim of biomedical research is to preserve health and improve patient outcomes. However, by a variety of measures, preservation of kidney health and patient outcomes in kidney disease are suboptimal. Severe acute kidney injury has been treated solely by renal replacement therapy for over 50 years and mortality still hovers at around 50%. Worldwide deaths from chronic kidney disease (CKD) increased by 80% in 20 years––one of the greatest increases among major causes of death. This dramatic data concur with huge advances in the cellular and molecular pathophysiology of kidney disease and its consequences. The gap appears to be the result of sequential roadblocks that impede an adequate flow from basic research to clinical development [translational research type 1 (T1), bench-to-bed and back] and from clinical development to clinical practice and widespread implementation (translational research T2) that supported by healthcare policy-making reaches all levels of society throughout the globe (sometimes called translational research T3). Thus, it is more than 10 years since the introduction of the last new-concept drug for CKD patients, cinacalcet; and 30 years since the introduction of reninangiotensin system (RAS) blockade, the current mainstay to prevent progression of CKD, illustrating the basic science-clinical practice disconnect. Roadblocks from clinical advances to widespread implementation, together with lag time-to-benefit may underlie the 20 years since the description of the antiproteinuric effect of RAS blockade to the observation of decreased age-adjusted incidence of endstage renal disease due to diabetic kidney disease. Only a correct understanding of the roadblocks in translational medicine and a full embracement of a translational research culture will spread the benefits of the biomedical revolution to its ultimate destinatary, the society.

Welcome to the new ckj: an open-access resource integrating clinical, translational and educational research into clinical practice

“…In this regard, a section should be added summarizing the key messages of the review including one item on how this knowledge may impact patient outcomes and what barriers should be overcome. A series of reviews has already been planned that will explore CKD hotspots around the world [ 12 – 14 ], translational research in nephrology [ 15 ], education and education research in nephrology and molecular pathology. In this section we will also publish reviews produced by the ERA-EDTA Scientific Working Groups, including the European Renal and Cardiovascular medicine (EURECA-m) working group (WG), the Immunonephrology WG, the WG on Inherited Kidney Disorders (WGIKD), the European Dialysis WG (EUDIAL), Developing Education Science and Care for Renal Transplantation in European States (DESCARTES), Working Group on Chronic Kidney Disease–Mineral and Bone Disorders (CKD-MBD) and the working group researching the nephrological impact in relation to diabetes and obesity (DIABESITY) [ 16 ].…”

Thrombotic microangiopathy: expanding genetic, clinical and therapeutic spectra and the need for worldwide implementation of recent advances

“…The article by Reddy et al [ 7 ] summarized the paediatric plasmapheresis experience in a South India centre between 2009 and 2013. This report represents a clear example of the gaps resulting from roadblocks in translational research T3 [ 18 ]. For research to benefit the worldwide population, three sequential steps are needed: the flow from basic research to clinical development [translational research type 1 (T1), bench-to-bedside and back], from clinical development to clinical practice (translational research T2) and finally, from clinical practice to widespread implementation at all levels of society throughout the globe (translational research T3) through a combination of healthcare policymaking, education and guideline development, access to diagnostic and therapeutic resources and implementation [ 18 ].…”

“…This report represents a clear example of the gaps resulting from roadblocks in translational research T3 [ 18 ]. For research to benefit the worldwide population, three sequential steps are needed: the flow from basic research to clinical development [translational research type 1 (T1), bench-to-bedside and back], from clinical development to clinical practice (translational research T2) and finally, from clinical practice to widespread implementation at all levels of society throughout the globe (translational research T3) through a combination of healthcare policymaking, education and guideline development, access to diagnostic and therapeutic resources and implementation [ 18 ]. Eculizumab was first marketed in the European Union on 20 June 2007 for adults and children with paroxysmal nocturnal haemoglobinuria [ 19 ], and in September 2011, the indication for atypical uraemic syndrome was granted [ 20 ].…”

Horizon 2020 in Diabetic Kidney Disease: The Clinical Trial Pipeline for Add-On Therapies on Top of Renin Angiotensin System Blockade

“…Any new therapy should be more effective than angiotensin converting enzyme (ACE) inhibitors or angiotensin type 1 receptor blockers (ARBs) in preventing loss of renal function in head-to-head comparisons or improve outcomes when used in addition to RAS blockade. In this regard, the widespread use of RAS blockade may underlie the observation that while DKD is still the most frequent cause of incident end-stage renal disease (ESRD) (almost 50% according to 2014 United States Renal Data System (USRDS) data) [ 4 ], and among persons with diabetes, the prevalence of DKD remained stable (thus exposing patients with increased risk associated with CKD) [ 5 ]; it is also true that the number of incident cases has stabilized in recent years and the incidence rate has started a slow decrease and this may be related to wider implementation of nephroprotective strategies [ 6 ]. Ethics considerations limit the possibilities regarding head-to-head comparisons.…”