NKF Cloaks Conflicts on Eve of Crucial Meeting

The non-profit National Kidney Foundation is refusing to release the final roster of the expert panel that meets in Dallas on Saturday to re-evaluate its anemia guidelines for people suffering from chronic kidney disease. Recent studies show that raising red blood cell counts to meet targets established in the 2006 NKF guidelines increases strokes and heart attacks for people on dialysis, and hastens the onset of dialysis for people with chronic kidney disease. Eleven of the 16 members of the committee behind those guidelines, which were underwritten by Amgen Inc., had ties to firms that sell drugs to alleviate anemia, which are Amgen, Roche and Johnson & Johnson. The government's Medicare program currently spends over $2 billion a year for these drugs.

The current roster on the NKF website lists 12 of 18 members with ties to those three firms. A spokesman for the group refused to answer questions about possible changes to the committee in the wake of recent criticism in The Lancet attacking both the guidelines and conflicts of interest in the NKF guideline-writing process. "We've decided to keep the membership anonymous," said Bryan VanSteenbergen, a spokesman for NKF.

In an article in the current issue of the Clinical Journal of the American Society of Nephrology, Daniel W. Coyne of Washington University School of Medicine in St. Louis blasted the committee's decision last year to ignore his own unpublished data showing excess mortality even though he offered the data from his industry-funded study to the committee. "In whose interest was it not to delay release of the guidelines until the results of these studies were available," he asked. In a written response, five physicians from the committee, four with ties to the drug makers, said reviewing only published studies "served as a safeguard against bias."

Coyne also attacked Medicare reimbursement policy, which rewards dialysis clinics for increased use of the drugs, and called on NKF to prohibit or "greatly limit" physicians with conflicts of interest from serving on its guideline-writing panels. "There are many physicians in academia with few or no ties to industry who are well trained to evaluate evidence from clinical trials and capable of writing guidelines," he told Integrity in Science Watch. "By not restricting corporate conflicts of interest among guideline panel members, the NKF has sometimes chosen physicians clearly favored by their sponsoring corporations, and effectively encourages those companies to attempt to influence all panel members." In the written response to his article, the NKF committee members said prohibiting physicians with conflicts from sitting on the panel "although attractive in theory, is unrealistic." They called instead for greater transparency.

Reprinted from today's Integrity in Science Watch.