The American Society of Nephrology gathered for its annual scientific meeting highlighting emerging science in kidney disease, this year in Philadelphia, an early capital city of the U.S. As a pediatric nephrologist, the Kidney Week programming to some degree often feels like being relegated to the kiddie table. Reflecting the smaller size of our patients, the smaller scale of Kidney Week programming focused on pediatric kidney disease nevertheless promised to deliver innovative clinical trial planning and cutting edge science, as well as address notable gaps in pediatric care.
Clinical trials investigating novel therapeutics often exclude pediatric participants and as such, new drugs are introduced into pediatric practice years after their introduction to adult patients, and SLGT2-inhibitors are no exception. The landmark clinical trials over the last 10 years have positioned “flozins” as a key component in the management of proteinuric CKD. Despite a lack of demonstrated evidence in pediatric patients, due to a presumed similar mechanism of action, SGLT2-inhibitors have started to enter clinical practice in pediatrics. On November 2, the session entitled “Clinical Trials in Pediatric CKD: Trial with SGLT2 Inhibitors?” moderated by the powerhouse Dr. Susan Furth, addressed the challenges of designing clinical trials for children and proposed a conceptual model for a pediatric clinical trial to study the effectiveness of SGLT2-inhibitors. This session included talks by expert clinicians and researchers, such as Drs. William Smoyer and Marva Moxey-Mims, who shared unique experiences and insights for developing and managing successful clinical trials. An incredibly unique aspect of this session includes parents of a child with CKD, highlighting how important the family and patient perspective are to research design. They provided critical insight to ensure that trials are designed to study the outcomes that are most important to our patients and families.
On Saturday, November 3, there was a session called “Innovative Immunosuppression and Monitoring Strategies in Pediatric Kidney Transplantation.” To start off the session, Dr. Eileen Chambers presented on current and emerging immunosuppressive therapies, then handed the baton to Dr. Dechu Puliyanda to discuss desensitization and treatment of antibody mediated rejection, two challenging clinical issues. Dr. Anat Tambur educated the participants on utility of molecular mismatch technologies, specifically eplet matching, and discussed the current limitations of this technology. Finally, building on the previous day’s session of developing clinical trials in pediatric patients, Dr. Briscoe presented on a new study, the ADVANTAGE Trial, that will test the use of costimulatory blockade in pediatric kidney transplantation.
Although cardiovascular disease is the leading cause of morbidity and mortality in children with kidney disease, the management of dyslipidemia in pediatric patients remains a gray area, both due to limited pharmacological options and differing recommendations between various clinical guidelines. The session “Dyslipidemia in Pediatric CKD: Risk for Stiff Vessels?” aimed to address this notable gap in current pediatric care. Notably, Dr. Ian Macumber discussed emerging evidence of the vascular effects of dyslipidemia in children and Dr. Rachel Shustak, a pediatric cardiologist, summarized the controversies regarding management of dyslipidemia in children. This session leaves us with a better understanding for how to manage this CKD complication, which has until now been met mostly with shoulder shrugs and best guesses from pediatric clinicians.
As always, a key aspect of these meetings is the opportunity to re-engage with colleagues from different institutions, strengthen and develop collaborations, share professional insights, and have personal experiences. The American Society of Pediatric Nephrology (ASPN) will hold meetings of their various committees, interest groups, and special programming including the Fellow’s Speed Mentoring Event, which has always been very well received. ASN remains the leading nephrology meeting in the U.S. and it’s great to see such cutting-edge science focused on children with kidney disease in the programming.
Olga Charnaya, MD has no conflicts of interest to report.
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