Glomerular Diseases: Registries and Clinical Trials.
Nephrology has conducted few high-quality clinical trials, and the trials that have been conducted have not resulted in the approval of new treatments for primary or inflammatory glomerular diseases. There are overarching process issues that affect the conduct of all clinical trials, but there are also some specialty-specific issues. Within nephrology, primary glomerular diseases are rare, making adequate recruitment for meaningful trials difficult. Nephrologists need better ways, beyond histopathology, to phenotype patients with glomerular diseases and stratify the risk for progression to ESRD. Rigorous trial design is needed for the testing of new therapies, where most patients with glomerular diseases are offered the opportunity to enroll in a clinical trial if standard therapies have failed or are lacking. Training programs to develop a core group of kidney specialists with expertise in the design and implementation of clinical trials are also needed. Registries of patients with glomerular disease and observational studies can aid in the ability to determine realistic estimates of disease prevalence and inform trial design through a better understanding of the natural history of disease. Some proposed changes to the Common Rule, the federal regulations governing the ethical conduct of research involving humans, and the emerging use of electronic health records may facilitate the efficiency of initiating multicenter clinical trials. Collaborations among academia, government scientific and regulatory agencies, industry, foundations, and patient advocacy groups can accelerate therapeutic development for these complex diseases.
Due to the number of contributing authors, the affiliations are provided in the Supplemental Material .
Marva M
MM
Moxey-Mims
Michael F
MF
Flessner
Lawrence
L
Holzman
Frederick
F
Kaskel
John R
JR
Sedor
William E
WE
Smoyer
Aliza M
AM
Thompson
Lynne
L
Yao
D015415:Biomarkers; D023381:Endpoint Determination; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy*; D054586:National Institute of Diabetes and Digestive and Kidney Diseases (U.S.); D009398:Nephrology; D009402:Nephrosis, Lipoid / Q000188:drug therapy; D010372:Pediatrics; D055818:Public-Private Sector Partnerships; D016032:Randomized Controlled Trials as Topic / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D012042:Registries; D012107:Research Design / Q000592:standards; D014481:United States
D015415:Biomarkers
Chronic; Cooperative Behavior; Electronic Health Records; Foundations; Government; Humans; Kidney Failure; Kidney Glomerulus; Patient Advocacy; Phenotype; Prevalence; Registries; Research; Science; Specialization; clinical trial; glomerular disease; kidney; nephrology; registries
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