Back to the Future: Paving the Way for the Next Generation of Renal Therapeutics

Chronic Kidney Disease (CKD) is a major global public health problem, as it is a driver of premature morbidity and mortality, and it exerts a high economic burden across public and private sectors and across geographic and demographic boundaries. During the 20th century, the field of nephrology developed and applied major technological advances that have resulted in our ability to provide dialysis and transplantation to patients whose native kidneys have failed. These major technological advances have resulted in the meaningful extension of life expectancy for millions of patients with end stage renal disease globally over the past fifty years. The application of these technologies has become routine, especially in the developed world, as the clinical, commercial, and operational infrastructure to provide ESRD care has evolved significantly. In addition, multiple pharmacologic strategies to inhibit the Renin Angiotensin System (RAS) have emerged, with the resultant ability to slow progression to ESRD for some patients with kidney diseases, most notably patients with Diabetic Nephropathy. However, even as these significant technological advances of dialysis and transplantation and pharmacologic inhibition of the RAS pathway have become routinely available, especially over the past two decades, the field of nephrology has unfortunately stagnated in terms of additional innovation for new technologies and therapeutics targeted at delaying or preventing renal failure. This is especially noticeable, since substantial progress in molecular medicine has been made in other fields recently, especially in oncology. Now is a critical time for field of nephrology to acknowledge our prior progress, to recognize current challenges to innovation, and to implement new drug development strategies, including the establishment and adoption of disease-specific biomarkers, with the goal of enabling and ensuring successful development of novel therapeutics to help patients at risk for renal failure. A strategic framework is offered to encourage the aggregate set of stakeholders interested in the development of the next generation of renal therapeutics.