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Observers estimate that about 19 million US adults have chronic kidney disease, roughly one in 10 of the adult population. Despite these huge numbers, there is a serious lack of good evidence to help inform their treatment, writes one leading nephrologist. Since 1966 fewer randomised trials have been published in nephrology than in any other branch of internal medicine. Not one good trial in the past 30 years has shown a clear mortality benefit for any treatment given to patients receiving dialysis. Long term survival hasn't improved in recent years and may even be getting worse.
US guidelines for the treatment of chronic kidney disease rely heavily on evidence from observational and epidemiological studies, and tend to focus more on processes of care rather than outcomes that matter to patients and their relatives, he says. This has to change, starting with a close look at why the nephrology research community has failed to conduct much needed trials. Barriers must be broken down and targets for recruitment set to shake researchers out of their complacency.
Cardiovascular researchers could also help by including patients with chronic kidney disease in large prevention or intervention trials. All patients with kidney disease have a high risk of cardiovascular events, but so far they have been systematically excluded from most important cardiovascular trials.