Dr. Joseph Flynn is a professor of pediatrics and chief of the Division of Nephrology at Seattle Children’s Hospital. His personal vision for clinical research can be summarized quite simply: “For years, I have felt that every patient that we see should be viewed as a potential research subject. We’ll never advance our understanding of diseases and their treatment unless we enroll patients in clinical research.”
At Seattle Children’s, nephrology clinic nurses actively enroll patients in registry studies and provide them with preliminary information about clinical trials. Dr. Flynn feels that this type of clinical and research teamwork should be happening everywhere and is glad to be part of the Pediatric Trials Network, which is moving pediatric clinical research in that direction.
Dr. Flynn’s own research focuses on the epidemiology and treatment of childhood hypertension (high blood pressure), as well as the cardiovascular complications of pediatric chronic kidney disease. The study that Dr. Flynn is most enthusiastic about is a large observational cohort study called the Chronic Kidney Disease in Children (CKiD) study. Underway since 2003, CKiD is looking at risk factors for progression of chronic kidney disease (CKD) and the impact of CKD on growth, neurocognitive development, and risk factors for cardiovascular disease. Approximately 730 children are currently enrolled at around 50 centers across the United States and Canada, and investigators are getting ready to apply to the National Institutes of Health for a third five-year grant.
“The CKid study is very exciting,” says Flynn. “We’ve been extremely productive in terms of what we’ve learned about these children.” In addition to two papers currently in the works, key findings from CKiD that Dr. Flynn has helped to publish include the following:
- Among children who are being followed at specialty centers for CKD, about 25% still have uncontrolled hypertension; even those who are being treated for hypertension still don’t have well-controlled blood pressure.
- About 20% of children with CKD have a high rate of thickening of the heart muscle—left ventricular hypertrophy—which is related to abnormalities on 24-hour ambulatory blood pressure monitoring.
- Many children with CKD have significant lipid abnormalities and other risk factors for heart disease.
- There appears to be an impairment of IQ in children with CKD who also have elevated blood pressure.
Not only is the CKid study providing important insights that will inform future research, it has also resulted in direct, immediate benefit to some individual study participants. For example, Flynn reports that assessments included as part of the study have led to changes in medication or referrals to additional specialists.
Registries: Fighting the Stereotype
Although patient registries are “probably the least sexy kind of research,” Dr. Flynn believes they are extremely important, especially in less common pediatric conditions like kidney disease. Having a large number of research centers pool their data provides much more meaningful information than would the data from just one or two centers. Such registry data can be invaluable for generating new hypotheses and increasing understanding of these diseases. “There are certain questions you can’t answer any other way,” observes Flynn.
For example, Seattle Children’s was one of several centers to collaborate on the International Pediatric Peritoneal Dialysis Network. This group agreed to treat pediatric patients with peritonitis in the same way and then to pool their data to assess how well that treatment protocol worked. “Well, we learned that it wasn’t a good way…that the way we had been doing before was actually better,” says Flynn. This network now includes over 140 institutions, has over 1700 patients enrolled, and works to continue improving the care of children on chronic peritoneal dialysis.
Breaking New Ground with Clinical Trials
In addition to observational and registry studies, Dr. Flynn is also active in several clinical trials. In one current study, Dr. Flynn and his colleagues are looking at a new class of antihypertensive medication (recently approved for adults) that directly inhibits renin, an important hormone in blood pressure regulation. Another ongoing study is testing different dosing regimens for a medication used to treat anemia in patients with chronic kidney disease.
Seattle Children’s has just joined the Pediatric Trials Network as a participating site, and Dr. Flynn and his team are looking forward to helping the PTN make contributions to understudied areas in pediatrics, including pharmacokinetic studies of commonly used medications, and studies in underserved age groups, such as neonates. Dr. Flynn has been an advisor to the BPCA office of the NICHD since 2005 and is excited to see the growth of the PTN. He hopes to guide Seattle Children’s participation in many PTN-sponsored trials.
When Dr. Flynn isn’t working on his research, seeing patients at Children’s, or making trips to outreach clinics across the northwest region, he can often be found traveling the world. As president-elect of the American Society of Pediatric Nephrology and a member of the governing council of the International Pediatric Nephrology Association, Flynn is frequently asked to travel to far-flung locations for meetings and talks. Last year, he followed visits to Japan and Brazil with an invited speaking engagement in Dubrovnik, Croatia, a place he found “fascinating and beautiful.” Closer to home, he enjoys visiting the San Juan Islands and camping in the Cascade Mountains. Of course, he thinks the views of the Olympic Mountains and the Space Needle from his are office pretty great, too!