- Email: [email protected]
Navigating Toward Research Success in Times of Uncertainty: Funding Opportunities for Early Career Investigators in Nephrology
Perspective Navigating Toward Research Success in Times of Uncertainty: Funding Opportunities for Early Career Investigators in Nephrology T. Alp Ikizler, MD,1 David H. Lovett, MD,2 Glenn M. Chertow, MD, MPH,3 William E. Mitch, MD,4 and Brigitte Schiller, MD3,5 There is considerable concern within the nephrology community about recent federal budget cuts and the decreasing availability of funds for research. This is especially difficult for junior investigators who are about to start a career as physician-scientists. Accordingly, it is imperative that resources other than federal funds be made available to these individuals during this most delicate yet crucial transition period. This commentary aims to provide an overview of nonfederal funding resources, focusing on the Norman S. Coplon Extramural Grant Program. This program emphasizes support of investigators at the most fragile period in their development of an academic career; it has provided .$11 million of research funds to more than 80 individuals since 2000. The outcome has been stellar, with more than 130 publications originating from these projects and .90% of awardees staying in academia. We hope these accomplishments will encourage similar activities by other entities and scientific programs in addition to ones that are ongoing. Ultimately, these collective efforts will inspire young researchers to use their knowledge, passion, and dedication to advance research into kidney diseases. Am J Kidney Dis. 65(3):381-383. ª 2015 by the National Kidney Foundation, Inc. INDEX WORDS: Physician-scientist; kidney disease.
Dr Norman S. Coplon passed away on January 13, 2015. The Norman S. Coplon Extramural Grant Program, discussed in this Perspective, is one of his many lasting legacies.
E
ven before recent federal budget cuts and the decreasing availability of federal funds for research,1 kidney disease research received lower levels of funding from the National Institutes of Health (NIH) compared with other chronic disease states. We believe this places nephrology at particular risk for limited scientific advancements. Given limited NIH funding, several professional organizations, such as the American Heart Association and American Diabetes Association, have expanded their support for their funding opportunities to include fellows and junior faculty. In terms of advances in kidney disease research, the American Society of Nephrology recently highlighted their commendable efforts to promote research.2 Our purpose is to raise awareness of other programs that support kidney disease research, focusing on a successful program with this philanthropic goal, namely the Norman S. Coplon Extramural Grant Program (EGP). Our ultimate goal is to encourage similar activities by other entities, as well as to encourage scientific programs that will provide a more optimistic outlook for kidney disease research while sparking enthusiasm among young investigators dedicated to developing programs that foster research careers in kidney disease. The Norman S. Coplon EGP was instituted by Satellite Healthcare, a mid-size not-for-profit dialysis Am J Kidney Dis. 2015;65(3):381-383
organization founded in 1974. Since its inception, Satellite Healthcare has supported research and exploration into the causes of and potential cures for kidney disease, participating in contract-based investigations, internal research, academic collaborations, and most importantly the Norman S. Coplon EGP. The Norman S. Coplon EGP began in 2000 with the goal of enabling young researchers to undertake clinical or basic research projects related to the diagnosis and treatment of kidney disease. The Norman S. Coplon EGP is governed by certain application requirements and overseen by an independent Scientific Advisory Board (SAB) composed of 8 to 9 investigators from various academic institutions. The requirements for funding are geared primarily to supporting young investigators, and a major aim is to provide bridge funding during the transition toward an independent career in research. Thus, the From the 1Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN; 2Department of Medicine, San Francisco Department of Veterans Affairs Medical Center and University of California San Francisco, San Francisco; 3Division of Nephrology, Stanford University, Palo Alto, CA; 4Nephrology Division, Department of Medicine, Baylor College of Medicine, Houston, TX; and 5Satellite Healthcare Inc, San Jose, CA. Received August 23, 2014. Accepted in revised form November 3, 2014. Originally published online December 23, 2014. Address correspondence to T. Alp Ikizler, MD, Vanderbilt University School of Medicine, Division of Nephrology, Medical Center North, S-3223, 1161 21st Ave, Nashville, TN 37232-2372. E-mail: [email protected] 2015 by the National Kidney Foundation, Inc. 0272-6386 http://dx.doi.org/10.1053/j.ajkd.2014.11.008 381
Ikizler et al Box 1. Outcomes of the Norman S. Coplon Extramural Grant Program General Summary Total no. of recipients: 80 Total no. of grants awarded: 81 Total amount awarded: $11,550,000 Current Recipient Professional Information Recipients affiliated with academic institutions: 74 No. of fellowship program directors: 11 NIH-Funded Projects Total principal investigators: 55 Total projects: 611 Total amount funded: $143,137,509a Abbreviation: NIH, National Institutes of Health. a The total amount does not include Veteran’s Affairs funding.
Norman S. Coplon EGP emphasizes support of investigators at the most fragile period in their lifetime. Consequently, investigators with independent funding (ie, NIH R01 or similar grant) or those with tenure are not eligible to apply. Members of the SAB rotate on a 3- to 5-year basis: to date, 25 different individuals have served as members of the SAB. Members of the SAB have been about equally distributed based on their expertise in basic or clinical research and have included past presidents of the American Society of Nephrology and the National Kidney Foundation. The Norman S. Coplon EGP also sponsors an annual symposium, which provides an interactive
forum for investigators supported by the EGP to share their findings with their peers and members of the SAB. Attendance at this annual symposium is a requirement for funding and has been enthusiastically endorsed by both awardees and SAB members as an opportunity to advance kidney disease research. The balance between basic science and patient-oriented research allows attendees to expand their horizons beyond their usual areas and encourages creativity and collaboration. Outcomes of the Norman S. Coplon EGP have been extraordinary by any measure (Box 1). A total of 80 recipients have been awarded 81 grants over a 12-year period, with the aggregate amount of funding $11,550,000. Awardees are from 41 academic institutions in the United States and Canada (no specific institution is allowed to receive multiple grants within the same funding year). The long-term success of the Norman S. Coplon EGP for its recipients also has been exceptional. Of the 80 recipients to date, 74 (93%) maintain full-time appointments in academic institutions. Current positions include division chiefs; fellowship program directors; full, associate, and assistant professors; and instructors. Norman S. Coplon EGP recipients have published more than 130 peer-reviewed publications citing the Norman S. Coplon EGP in prestigious journals, including the Journal of Clinical Investigation, Nature Medicine, New England Journal of Medicine, Journal
Table 1. Several Examples of Nonfederal Funding Opportunities in Nephrology Funding Organization
Target Audience
Goal
Scientific Target
N per y
$ Amount per y
American Kidney Fund
Fellow
Postdoctoral training
Clinical
1-2
$80,000
American Society of Nephrology
Fellow
Postdoctoral training
Clinical and basic
10
$50,000
American Society of Nephrologya
Junior faculty
Bridge funding
Clinical and basic
6-11
$100,000
International Society of Nephrologyb
Fellows from emerging countries
Postdoctoral training
Clinical and basic
w45
w$25,000
National Kidney Foundation
Junior faculty
Bridge funding
Clinical and basic
5
$20,000
Nephcure Kidney International
Trainees, young or established investigators
Postdoctoral training; bridge funding; investigator initiated
Clinical and basic
Varies
$75,000
Satellite Healthcare
Junior faculty
Bridge funding
Clinical and basic
5
$100,000
Paul Teschan Research Fundc
Affiliated with Dialysis Clinic, Inc
Pilot & feasibility
Clinical and basic
5-9
$60,000
PKD Foundationd
Trainees, young or established investigators
Investigator-initiated research
Clinical and basic
Varies
Varies
a Includes funding for Gottschalk, Merrill, and Siegel junior faculty grants and Halpin Foundation co-grants. The range is dependent on the year of funding. b To sponsor relevant and contemporary nephrology training to physicians from emerging countries, with the goal of improving the standards in the fellows’ home countries in nephrology and becoming leaders in their fields. c Must be affiliated with a Dialysis Clinic, Inc clinic to be eligible for funding because recipient must be sponsored by a Dialysis Clinic, Inc medical director. Each grant is up to $60,000 per year and can be renewed twice for a total of 3 years. The number of grants awarded each year is determined by peer and committee reviews and the amount of funds donated by the clinics. d Funding dependent on the year.
382
Am J Kidney Dis. 2015;65(3):381-383
Research in Kidney Disease
of the American Society of Nephrology, Clinical Journal of the American Society of Nephrology, and American Journal of Kidney Diseases. The number of publications from these individuals is more than 1,000. One of the major goals of the Norman S. Coplon EGP is to provide an opportunity for the recipient to secure NIH funding. Of the 80 recipients, 55 have participated in NIH projects as a principal investigator, for a total of 611 projects, with an additional 120 subprojects encompassing a variety of research projects. The total amount of funding awarded to all principal investigators (for all 611 projects) is w$143 million over 12 years, with funding coming from multiple institutes and the Department of Veteran Affairs, Office of Research and Development. The Norman S. Coplon EGP has funded research that has changed clinical practice. For example, the EGP supported the gathering of preliminary data arising from sophisticated metabolic studies in dialysis patients; these results formed the basis for developing nutritional guidance for patients with end-stage renal disease,3 including experimental data supporting the use of oral nutritional supplements during hemodialysis that resulted in a change in federal guidelines for the provision of oral nutritional supplements to maintenance dialysis patients.4 Other examples include a community-based study supported by EGP that led to extensive discussion on health care policies relevant to traditionally underserved populations5 and studies by a group of Canadian investigators that helped establish new biomarkers for acute kidney injury and acute transplant rejection.6 In summary, despite the difficulties obtaining funding from well-established sources (eg, NIH) that are well documented, there are opportunities that support young dedicated investigators who are committed to fulfilling their research goals and aspirations (Table 1). The Norman S. Coplon EGP represents one of these opportunities. The return on investment from this program constitutes high-quality evidence that the program has been successful. However, meaningful research advancements can be accomplished only if other organizations, including and beyond those cited in Table 1, respond to the challenge and take an active role in prioritizing the funding of research and knowledge generation. In this time of financial restraint, the Norman S. Coplon EGP is an outstanding example of an entity that not only provides peer-reviewed funding, but also has been successful in promoting scientific evaluations of important clinical questions. Importantly, this effort encourages young researchers to use their knowledge,
Am J Kidney Dis. 2015;65(3):381-383
passion, and dedication to advance research into kidney diseases.
ACKNOWLEDGEMENTS We thank previous and current members of the SAB for invaluable contributions to the Norman Coplon EGP: Rajiv Agarwal, MD, Indiana University School of Medicine, Indianapolis, IN; Peter Blake, MD, University of Western Ontario, London, ON, Canada; Allan Collins, MD, University of Minnesota, Minneapolis, MN; Connie L. Davis, MD, University of Washington, Seattle, WA; Sarah Faubel, MD, University of Colorado, Denver, CO; Robert Foley, MD, Chronic Disease Research Group, Minneapolis, MN; William Henrich, MD, The University of Texas Health Science Center, San Antonio, TX; Jonathan Himmelfarb, MD, University of Washington, Seattle, WA; Thomas Hostetter, MD, Albert Einstein College of Medicine, Bronx, NY; Chi-yuan Hsu, MD, University of California, San Francisco, CA; Lawrence Hunsicker, MD, University of Iowa Healthcare, Iowa City, IA; Saulo Klahr, MD, Washington University in St Louis, St Louis, MO; Stuart Linas, MD, University of Colorado, Denver, CO; William McClellan, MD, MPH, Emory University Rollins School of Public Health, Atlanta, GA; Timothy Meyer, MD, Stanford School of Medicine, Palo Alto, CA; Bruce Molitoris, MD, Indiana University Medical Center, Indianapolis, IN; Barbara Murphy, MD, Mount Sinai School of Medicine, New York, NY; Sanjay Nigam, MD, University of California San Diego, San Diego, CA; Milagros Samaniego-Picota, MD, University of Michigan, Ann Arbor, MI; Jeff Sands, MD, Emory University School of Medicine, Atlanta, GA; Jane Tan, MD, Stanford School of Medicine, Palo Alto, CA; N.D. Vaziri, MD, University of California, Irvine, CA; Jane Yeun, MD, University of California, Davis, CA; The authors also acknowledge the invaluable efforts of Dana Barron, Hayley Munroe, and Nate Slesnick in the successful administration of this program and compiling the data for this manuscript. Support: None. Financial Disclosure: Drs Ikizler, Chertow, Lovett, and Mitch were/are consultants to Satellite Healthcare, Inc for their work as SAB members. Dr Chertow is a member of the Board of Directors at Satellite Healthcare. Dr Schiller is an employee of Satellite Healthcare, Inc.
REFERENCES 1. Garrison HH, Deschamps AM. NIH research funding and early career physician scientists: continuing challenges in the 21st century. FASEB J. 2014;28(3):1049-1058. 2. Bryan L, Ibrahim T, Zent R, Fischer MJ. The kidney research predicament. J Am Soc Nephrol. 2014;25(5):898-903. 3. Ikizler TA, Cano NJ, Franch H, et al. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int. 2013;84(6):1096-1107. 4. Pupim LB, Majchrzak KM, Flakoll PJ, Ikizler TA. Intradialytic oral nutrition improves protein homeostasis in chronic hemodialysis patients with deranged nutritional status. J Am Soc Nephrol. 2006;17(11):3149-3157. 5. Hall YN, Choi AI, Chertow GM, Bindman AB. Chronic kidney disease in the urban poor. Clin J Am Soc Nephrol. 2010;5(5):828-835. 6. Ho J, Wiebe C, Gibson IW, et al. Elevated urinary CCL2: Cr at 6 months is associated with renal allograft interstitial fibrosis and inflammation at 24 months. Transplantation. 2014;98(1):39-46.
383
Dr Norman S. Coplon passed away on January 13, 2015. The Norman S. Coplon Extramural Grant Program, discussed in this Perspective, is one of his many lasting legacies.
E
ven before recent federal budget cuts and the decreasing availability of federal funds for research,1 kidney disease research received lower levels of funding from the National Institutes of Health (NIH) compared with other chronic disease states. We believe this places nephrology at particular risk for limited scientific advancements. Given limited NIH funding, several professional organizations, such as the American Heart Association and American Diabetes Association, have expanded their support for their funding opportunities to include fellows and junior faculty. In terms of advances in kidney disease research, the American Society of Nephrology recently highlighted their commendable efforts to promote research.2 Our purpose is to raise awareness of other programs that support kidney disease research, focusing on a successful program with this philanthropic goal, namely the Norman S. Coplon Extramural Grant Program (EGP). Our ultimate goal is to encourage similar activities by other entities, as well as to encourage scientific programs that will provide a more optimistic outlook for kidney disease research while sparking enthusiasm among young investigators dedicated to developing programs that foster research careers in kidney disease. The Norman S. Coplon EGP was instituted by Satellite Healthcare, a mid-size not-for-profit dialysis Am J Kidney Dis. 2015;65(3):381-383
organization founded in 1974. Since its inception, Satellite Healthcare has supported research and exploration into the causes of and potential cures for kidney disease, participating in contract-based investigations, internal research, academic collaborations, and most importantly the Norman S. Coplon EGP. The Norman S. Coplon EGP began in 2000 with the goal of enabling young researchers to undertake clinical or basic research projects related to the diagnosis and treatment of kidney disease. The Norman S. Coplon EGP is governed by certain application requirements and overseen by an independent Scientific Advisory Board (SAB) composed of 8 to 9 investigators from various academic institutions. The requirements for funding are geared primarily to supporting young investigators, and a major aim is to provide bridge funding during the transition toward an independent career in research. Thus, the From the 1Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN; 2Department of Medicine, San Francisco Department of Veterans Affairs Medical Center and University of California San Francisco, San Francisco; 3Division of Nephrology, Stanford University, Palo Alto, CA; 4Nephrology Division, Department of Medicine, Baylor College of Medicine, Houston, TX; and 5Satellite Healthcare Inc, San Jose, CA. Received August 23, 2014. Accepted in revised form November 3, 2014. Originally published online December 23, 2014. Address correspondence to T. Alp Ikizler, MD, Vanderbilt University School of Medicine, Division of Nephrology, Medical Center North, S-3223, 1161 21st Ave, Nashville, TN 37232-2372. E-mail: [email protected] 2015 by the National Kidney Foundation, Inc. 0272-6386 http://dx.doi.org/10.1053/j.ajkd.2014.11.008 381
Ikizler et al Box 1. Outcomes of the Norman S. Coplon Extramural Grant Program General Summary Total no. of recipients: 80 Total no. of grants awarded: 81 Total amount awarded: $11,550,000 Current Recipient Professional Information Recipients affiliated with academic institutions: 74 No. of fellowship program directors: 11 NIH-Funded Projects Total principal investigators: 55 Total projects: 611 Total amount funded: $143,137,509a Abbreviation: NIH, National Institutes of Health. a The total amount does not include Veteran’s Affairs funding.
Norman S. Coplon EGP emphasizes support of investigators at the most fragile period in their lifetime. Consequently, investigators with independent funding (ie, NIH R01 or similar grant) or those with tenure are not eligible to apply. Members of the SAB rotate on a 3- to 5-year basis: to date, 25 different individuals have served as members of the SAB. Members of the SAB have been about equally distributed based on their expertise in basic or clinical research and have included past presidents of the American Society of Nephrology and the National Kidney Foundation. The Norman S. Coplon EGP also sponsors an annual symposium, which provides an interactive
forum for investigators supported by the EGP to share their findings with their peers and members of the SAB. Attendance at this annual symposium is a requirement for funding and has been enthusiastically endorsed by both awardees and SAB members as an opportunity to advance kidney disease research. The balance between basic science and patient-oriented research allows attendees to expand their horizons beyond their usual areas and encourages creativity and collaboration. Outcomes of the Norman S. Coplon EGP have been extraordinary by any measure (Box 1). A total of 80 recipients have been awarded 81 grants over a 12-year period, with the aggregate amount of funding $11,550,000. Awardees are from 41 academic institutions in the United States and Canada (no specific institution is allowed to receive multiple grants within the same funding year). The long-term success of the Norman S. Coplon EGP for its recipients also has been exceptional. Of the 80 recipients to date, 74 (93%) maintain full-time appointments in academic institutions. Current positions include division chiefs; fellowship program directors; full, associate, and assistant professors; and instructors. Norman S. Coplon EGP recipients have published more than 130 peer-reviewed publications citing the Norman S. Coplon EGP in prestigious journals, including the Journal of Clinical Investigation, Nature Medicine, New England Journal of Medicine, Journal
Table 1. Several Examples of Nonfederal Funding Opportunities in Nephrology Funding Organization
Target Audience
Goal
Scientific Target
N per y
$ Amount per y
American Kidney Fund
Fellow
Postdoctoral training
Clinical
1-2
$80,000
American Society of Nephrology
Fellow
Postdoctoral training
Clinical and basic
10
$50,000
American Society of Nephrologya
Junior faculty
Bridge funding
Clinical and basic
6-11
$100,000
International Society of Nephrologyb
Fellows from emerging countries
Postdoctoral training
Clinical and basic
w45
w$25,000
National Kidney Foundation
Junior faculty
Bridge funding
Clinical and basic
5
$20,000
Nephcure Kidney International
Trainees, young or established investigators
Postdoctoral training; bridge funding; investigator initiated
Clinical and basic
Varies
$75,000
Satellite Healthcare
Junior faculty
Bridge funding
Clinical and basic
5
$100,000
Paul Teschan Research Fundc
Affiliated with Dialysis Clinic, Inc
Pilot & feasibility
Clinical and basic
5-9
$60,000
PKD Foundationd
Trainees, young or established investigators
Investigator-initiated research
Clinical and basic
Varies
Varies
a Includes funding for Gottschalk, Merrill, and Siegel junior faculty grants and Halpin Foundation co-grants. The range is dependent on the year of funding. b To sponsor relevant and contemporary nephrology training to physicians from emerging countries, with the goal of improving the standards in the fellows’ home countries in nephrology and becoming leaders in their fields. c Must be affiliated with a Dialysis Clinic, Inc clinic to be eligible for funding because recipient must be sponsored by a Dialysis Clinic, Inc medical director. Each grant is up to $60,000 per year and can be renewed twice for a total of 3 years. The number of grants awarded each year is determined by peer and committee reviews and the amount of funds donated by the clinics. d Funding dependent on the year.
382
Am J Kidney Dis. 2015;65(3):381-383
Research in Kidney Disease
of the American Society of Nephrology, Clinical Journal of the American Society of Nephrology, and American Journal of Kidney Diseases. The number of publications from these individuals is more than 1,000. One of the major goals of the Norman S. Coplon EGP is to provide an opportunity for the recipient to secure NIH funding. Of the 80 recipients, 55 have participated in NIH projects as a principal investigator, for a total of 611 projects, with an additional 120 subprojects encompassing a variety of research projects. The total amount of funding awarded to all principal investigators (for all 611 projects) is w$143 million over 12 years, with funding coming from multiple institutes and the Department of Veteran Affairs, Office of Research and Development. The Norman S. Coplon EGP has funded research that has changed clinical practice. For example, the EGP supported the gathering of preliminary data arising from sophisticated metabolic studies in dialysis patients; these results formed the basis for developing nutritional guidance for patients with end-stage renal disease,3 including experimental data supporting the use of oral nutritional supplements during hemodialysis that resulted in a change in federal guidelines for the provision of oral nutritional supplements to maintenance dialysis patients.4 Other examples include a community-based study supported by EGP that led to extensive discussion on health care policies relevant to traditionally underserved populations5 and studies by a group of Canadian investigators that helped establish new biomarkers for acute kidney injury and acute transplant rejection.6 In summary, despite the difficulties obtaining funding from well-established sources (eg, NIH) that are well documented, there are opportunities that support young dedicated investigators who are committed to fulfilling their research goals and aspirations (Table 1). The Norman S. Coplon EGP represents one of these opportunities. The return on investment from this program constitutes high-quality evidence that the program has been successful. However, meaningful research advancements can be accomplished only if other organizations, including and beyond those cited in Table 1, respond to the challenge and take an active role in prioritizing the funding of research and knowledge generation. In this time of financial restraint, the Norman S. Coplon EGP is an outstanding example of an entity that not only provides peer-reviewed funding, but also has been successful in promoting scientific evaluations of important clinical questions. Importantly, this effort encourages young researchers to use their knowledge,
Am J Kidney Dis. 2015;65(3):381-383
passion, and dedication to advance research into kidney diseases.
ACKNOWLEDGEMENTS We thank previous and current members of the SAB for invaluable contributions to the Norman Coplon EGP: Rajiv Agarwal, MD, Indiana University School of Medicine, Indianapolis, IN; Peter Blake, MD, University of Western Ontario, London, ON, Canada; Allan Collins, MD, University of Minnesota, Minneapolis, MN; Connie L. Davis, MD, University of Washington, Seattle, WA; Sarah Faubel, MD, University of Colorado, Denver, CO; Robert Foley, MD, Chronic Disease Research Group, Minneapolis, MN; William Henrich, MD, The University of Texas Health Science Center, San Antonio, TX; Jonathan Himmelfarb, MD, University of Washington, Seattle, WA; Thomas Hostetter, MD, Albert Einstein College of Medicine, Bronx, NY; Chi-yuan Hsu, MD, University of California, San Francisco, CA; Lawrence Hunsicker, MD, University of Iowa Healthcare, Iowa City, IA; Saulo Klahr, MD, Washington University in St Louis, St Louis, MO; Stuart Linas, MD, University of Colorado, Denver, CO; William McClellan, MD, MPH, Emory University Rollins School of Public Health, Atlanta, GA; Timothy Meyer, MD, Stanford School of Medicine, Palo Alto, CA; Bruce Molitoris, MD, Indiana University Medical Center, Indianapolis, IN; Barbara Murphy, MD, Mount Sinai School of Medicine, New York, NY; Sanjay Nigam, MD, University of California San Diego, San Diego, CA; Milagros Samaniego-Picota, MD, University of Michigan, Ann Arbor, MI; Jeff Sands, MD, Emory University School of Medicine, Atlanta, GA; Jane Tan, MD, Stanford School of Medicine, Palo Alto, CA; N.D. Vaziri, MD, University of California, Irvine, CA; Jane Yeun, MD, University of California, Davis, CA; The authors also acknowledge the invaluable efforts of Dana Barron, Hayley Munroe, and Nate Slesnick in the successful administration of this program and compiling the data for this manuscript. Support: None. Financial Disclosure: Drs Ikizler, Chertow, Lovett, and Mitch were/are consultants to Satellite Healthcare, Inc for their work as SAB members. Dr Chertow is a member of the Board of Directors at Satellite Healthcare. Dr Schiller is an employee of Satellite Healthcare, Inc.
REFERENCES 1. Garrison HH, Deschamps AM. NIH research funding and early career physician scientists: continuing challenges in the 21st century. FASEB J. 2014;28(3):1049-1058. 2. Bryan L, Ibrahim T, Zent R, Fischer MJ. The kidney research predicament. J Am Soc Nephrol. 2014;25(5):898-903. 3. Ikizler TA, Cano NJ, Franch H, et al. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int. 2013;84(6):1096-1107. 4. Pupim LB, Majchrzak KM, Flakoll PJ, Ikizler TA. Intradialytic oral nutrition improves protein homeostasis in chronic hemodialysis patients with deranged nutritional status. J Am Soc Nephrol. 2006;17(11):3149-3157. 5. Hall YN, Choi AI, Chertow GM, Bindman AB. Chronic kidney disease in the urban poor. Clin J Am Soc Nephrol. 2010;5(5):828-835. 6. Ho J, Wiebe C, Gibson IW, et al. Elevated urinary CCL2: Cr at 6 months is associated with renal allograft interstitial fibrosis and inflammation at 24 months. Transplantation. 2014;98(1):39-46.
383