CKD Research at Arbor Research
From pioneering prospective research to EHR-powered evidence — leading the future of CKD research.
From pioneering prospective research to EHR-powered evidence — leading the future of CKD research.
The Evolution: EHR-Based CKD Research
Building on the foundation laid by CKDopps, Arbor Research has modernized its approach to CKD evidence generation through innovative EHR-based data partnerships. This represents a natural evolution: the same scientific rigor, epidemiologic expertise, and nephrology domain knowledge — now applied to larger, richer, and more cost-efficient real-world data sources.
Germany
Partnership with the Deutsche Nierenstiftung (DN) CKD clinic network, providing EHR data from a large, well-characterized population of CKD patients managed by nephrologists.
United States
Partnership with the National Association of Nephrology Institutes (NANI), providing granular EHR data on labs, medications, and clinical outcomes across a broad CKD population, with opportunities to collaborate on ancillary studies.
Kuwait
EHR-based CKD cohort providing a global perspective on CKD management and outcomes.
Together, these partnerships provide access to EHR data from more than 100,000 CKD patients, enabling a new generation of real-world evidence studies on disease progression, treatment effectiveness, guideline adherence, and health policy impact.
International PD Prescription Variation
PDOPPS revealed substantial international differences in PD modality use (CAPD vs. APD), prescribed dialysis volumes, and use of icodextrin, with U.S. patients notably underutilizing icodextrin relative to other countries. These findings provide actionable benchmarks for optimizing PD prescriptions worldwide.
Key Focus Areas in CKD Research
Cardiovascular-Kidney-Metabolic (CKM) Syndrome
The American Heart Association’s 2023 Presidential Advisory defined CKM syndrome as a systemic disorder reflecting the pathophysiological connections among cardiovascular disease, kidney disease, diabetes, and obesity. With large EHR-based CKD populations and deep nephrology expertise, Arbor Research is uniquely positioned to generate evidence at the intersection of these interconnected conditions — including real-world studies of SGLT2 inhibitors, GLP-1 receptor agonists, and finerenone in CKD populations.
Diabetes and Obesity in CKD
Diabetic kidney disease remains the leading cause of CKD progression and kidney failure. The emergence of GLP-1 receptor agonists and other novel agents with both metabolic and renal benefits has created urgent demand for real-world evidence on treatment patterns, effectiveness, and long-term outcomes in CKD patients with diabetes and obesity.
Rare Kidney Diseases
There is growing therapeutic innovation in conditions such as IgA nephropathy, FSGS, APOL1-associated kidney disease, and genetic kidney disorders including ADPKD, Alport syndrome, and Fabry disease. Large EHR-based cohorts offer a powerful platform for natural history studies, treatment utilization analyses, and real-world effectiveness studies in these populations.
The Foundation: The CKD Outcomes and Practice Patterns Study (CKDopps)
The Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) was designed to address a critical evidence gap: the management and outcomes of patients with advanced, non-dialysis-dependent CKD — a high-risk population facing enormous clinical and economic burden.
Extending the DOPPS model upstream in the kidney disease continuum, CKDopps established a prospective research platform to study CKD treatment variation and identify practices associated with the best outcomes. The study enrolled patients from nephrology practices in Brazil, France, Germany, Japan, and the United States, with a collaborative team of country investigators and an international steering committee.
Key research themes included treatment variation and guideline adherence; the transition to dialysis, including timing, access preparation, and modality selection; CKD-MBD and anemia management; cardiovascular risk; patient-reported outcomes (PROs) and symptom burden; and conservative kidney management.
Key CKDopps Findings
KDIGO Guideline Adherence Across Countries
CKDopps provided the first systematic, international assessment of real-world adherence to KDIGO 2012 CKD guidelines. The study found significant gaps in achievement of blood pressure targets, RAAS inhibitor use, and albuminuria monitoring across nephrology practices in Brazil, France, Germany, and the United States — providing an actionable benchmark for quality improvement.
Symptom Burden in Non-Dialysis CKD
CKDopps data from more than 4,400 patients across three countries showed that patients with moderate-to-severe CKD experience a substantial and under-recognized symptom burden — including muscle soreness, fatigue, cramps, and shortness of breath — which was strongly associated with poorer physical and mental health-related quality of life, even before dialysis.
Conservative Kidney Management
CKDopps data from U.S. nephrology clinics revealed that only 7% of patients with advanced CKD were planning for conservative kidney management, and only 18% of surveyed patients reported having a conversation with their provider about forgoing dialysis — highlighting a major gap in shared decision-making and end-of-life care planning.
The Transition to Dialysis
CKDopps provided detailed international data on vascular access creation patterns, dialysis modality selection, and timing of dialysis initiation across countries, contributing to the evidence base for KDIGO and KDOQI guideline recommendations on the transition period.
What This Means for Partners
Arbor Research offers evidence generation across the full CKD spectrum, from early-stage CKD management to the transition to dialysis and beyond.
Our approach supports flexible study designs — observational cohort studies, target trial emulation, synthetic control arms, policy research, and more — all leveraging real-world CKD data.
EHR-based data eliminates the time and cost of prospective enrollment, enabling faster answers to clinical and commercial questions. And our international data assets allow cross-country comparisons to provide context for clinical development programs.
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