Inspiration + Healing
Altering the Course of Care
Of all the clinical specialties, nephrology lags far behind in the number of randomized controlled trials conducted over the past 30 years. The few trials that have been conducted have generated dramatic results and altered the course of care for patients with kidney failure. Research established EPO as a centerpiece for anemia management, reducing the need for blood transfusions in ESRD patients. Later research revealed that there were limits to its benefits. We have clear landmark studies establishing dialysis adequacy guidelines (and many of these studies were designed and conducted by our founders). However, beyond this there are few studies to establish the benefit and safety of many of the practices we do in dialysis. Many more studies are needed to answer these unanswered questions. Furthermore, we have learned that results from studies done in patients not on dialysis cannot be assumed to help dialysis patients. The best example of this is that statins, the frontline treatment for cardiovascular disease in almost all patients, has been shown to have no benefit for dialysis patients.
By integrating the dialysis care provided by IRC and the integrated care provided in their health care system we can create a more connected patient record. This allows dialysis patients more access to trials and allows better tracking of care, treatments and outcomes to develop hypotheses for future studies.
As the number of partners and patients within our network grows, we will continually search for new hypotheses to test. We will remain connected to the most important researchers in kidney disease, kidney transplant, pharmaceutical drug development and bio-engineering. Working with you through our not-for-profit research arm, we’ll propose new randomized controlled trials, seek grant funding to support these studies, and recruit study participants with our partners and act as a remote mentor to sites running studies.
Evidence + Based
Need for Randomized Trials
The dialysis experience is often structurally separate from all of the other clinical interventions that these patients experience.
Mortality and morbidity are often associated with underlying diseases that led to kidney failure – hypertension, diabetes and cardiovascular disease
Most studies exclude dialysis patients because of their complexity or the fact that the excretion and dosing of drugs varies in them or because of a worry for safety.
Focus + Determination
Addressing New Big Questions
Rigorous clinical research is part of the IRC DNA. From our Founders to our Board, from our Chairman to our Physician Partners, clinical research in nephrology has been a gravitational center of their professional lives.
We know that patients with chronic kidney disease have not benefitted from clinical research as patients with cancer or HIV or cardiovascular disease. Working with our provider partners we intend to redress the imbalance. We expect these and other questions to be generated by our physicians, nurses, pharmacists, dieticians, patient care technicians and entire IRC expanded care team. These questions can be addressed in small studies at a few sites, or as larger pragmatic trials at many sites, and ideally, in large randomized trials throughout our system.
Curiosity + Discovery
Cardiovascular disease is the leading cause of death in dialysis patients. Interventions to reduce cardiovascular risk need to be studied, and dialysis patients can be included in larger randomized trials of cardiovascular protection.
The second leading cause of death for dialysis patients is infection. Where in the dialysis process are infectious agents potentially introduced? What techniques and prophylactic interventions can be tested to reduce and manage infections? What are the best ways to attack infections once they take hold? And how can these practices be translated from hospital facilities to free-standing outpatient clinics and ultimately to home dialysis?
The research team at IRC has described a number of new directions in ESRD research
We are at the frontier of generating new evidence to benefit our patients
Care + Compassion
Antibiotic regimens for dialysis patients largely follow practices established for the general population. But we know that patients with both acute kidney injury and end stage renal disease metabolize drugs differently and clear those drugs in very different ways. Are novel ways to dose antibiotics necessary in AKI and ESRD?
What techniques best improve adherence in ESRD patients? Will techniques that empower patients and increase patient engagement that are well-established in other patient populations prove helpful to our patients?