A proposal for improving evidence generation in nephrology.

The existing framework for the evaluation and reimbursement of new drugs and other treatments in nephrology does not appear to be providing the optimal incentives to advance science and improve outcomes for patients with end-stage renal disease. This article examines reasons for this malalignment and how the field of nephrology is affected, then proceeds to show that alternative evaluation paradigms are being developed by the health technology assessment community. These alternative evaluative frameworks are complementary to traditional evidence-based medicine and comparative evaluative research and may be worthy of adaptation by those interested in seeing more pivotal kidney research (both quantity and quality) and more efficient evaluation of new therapies for patients with chronic kidney failure treated using long-term dialysis therapy.