Changing of the Guard

~

AMERICAN

The Official Journal of

..... The National Kidney Foundation

JOURNAL OF

KIDNEY DISEASES

VOL IX, NO 1, JANUARY 1987

EDITORIAL

Changing of the Guard

T

HE EDITORIAL OFFICE of the Journal has now moved across the country from Portland, Oregon to Birmingham, Alabama. Since the first issue in the Summer of 1981, George Porter and his Assistant Editor, Bill Bennett, have guided the Journal from bimonthly to monthly publication and established its reputation 'as a respected publication devoted to all aspects of kidney disease. To George and Bill go the gratitude of the readers, of the National Kidney Foundation, and of the new Editor. My goals for the Journal are to make it indispensable reading for all physicians who care for patients with kidney disease, of relevance to all students and scientists interested in renal pathophysiology, and attractive as a publication medium for those who labor to establish clinical truths and improve patient care. Clinical scientific studies are more difficult to conduct properly than those in basic science, but equally rigorous standards of excellence should apply in peer review. These standards, however, should be interpreted with the understanding that accurate control of all variables is not often possible, even in the best organized clinical investigation, especially if the subjects are ill patients. As long as this is openly stated, the findings may yet be of much value. Prospective controlled studies, although preferred, are not always feasible; conclusions from intelligent recording and collection of clinical information can be helpful to clinicians, provided the findings are interpreted in an appropriately guarded fashion with open acknowledgment of alternative explanations. For example, a prospective controlled randomized study of renal replacement therapy with some form of dialysis therapy as compared to transplantation is not feasible in a free society; patients will

not, and should not, agree to be randomized to such different forms of therapy. The same problem exists for a comparison of continuous ambulatory peritoneal dialysis (CAPD) with chronic hemodialysis. This does not mean, however, that we cannot make meaningful comparisons, again with open recognition of the limitations of our methods and with use of the best of statistical science to adjust for these variables. Whenever possible, statistical advice should be sought before initiating a prospective study. This is our editorial policy: encouragement of clinical studies, prospective and controlled if possible; if not, we hope that authors will make careful conclusions with open recognition of the pitfalls. We also welcome submission of clinically relevant studies from the laboratory and with animal models of disease. The Journal also has two new Assistant Editors in Birmingham (John Curtis, MD, and Jay Galla, MD), seven Associate Editors, and a revised Editorial Board. I have tried to select as Associate and Assistant Editors physicians who both exemplify the virtue of taking basic science to the bedside and to the medical classroom, and who represent the major clinical disciplines devoted to the kidney, including adult and pediatric nephrology, urology, renal transplantation, renal pharmacology, nephropathology, and physiology. We intend to continue traditions established by Dr Porter. The major annual symposium of the National Kidney Foundation, as selected by their Scientific Advisory Board, will be published; in 1985 it was "Hypertension and the Kidney" and last year it was "Growth in Children with Renal Disease." This year the symposium will be "Pregnancy and the Kidney." We will also seek to pub-

American Journal of Kidney Diseases, Vol IX, No 1 (January), 1987: pp 1-2

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lish the most appropriate symposium from the Annual Scientific Meeting of the National Kidney Foundation held each December. "Looking Upon the Water," those frothy pieces by Ken Gardner, will continue quarterly. We will introduce a "Physiology and Cell Biology Update" for nephrologists to let them know which developments are most exciting in basic science and may impact in the future on diagnosis and treatment. There will also be regular contributions by Dr Striker, Director of the Division of Kidney, Urologic and Hematologic Disease at NIH, to keep us informed on the Institute's activities relevant to the kidney. We will invite submissions of succinct reports of interesting renal biopsy cases with important clinicopathologic correlations; Dr Kashgarian will edit this new feature . Similarly, Dr Narins will solicit and edit monthly fluid-electrolyte-acid-base

ROBERT G. LUKE

vignettes that illustrate important pathophysiologic issues. The backbone of the Journal will, however, remain original articles from our readers. Prompt and fair review is our goal. As the incoming Editor, I welcome your suggestions and comments on the Journal. I am fortunate to have seen our subspeciality move from perhaps the most erudite and esoteric one in internal medicine, to one in which virtually no patient with kidney failure need die prematurely for that reason. Renal replacement therapy is relatively successful and routine, but expensive. I hope that the Journal can record its share of the milestones as we move toward the next goal, the prevention or considerable delay of end-stage renal disease. Robert G. Luke, MD University of Alabama Birmingham, Alabama