West Meets East

nary protein excretion, preferably with agents that block the renin-angiotensin pathway, and good glycemic control for diabetic patients [5] . Human studies have shown that proteinuria is an independent predictor of progression and that its reduction is renoprotective [6] . At comparable blood pressure control, inhibitors of the reninangiotensin system (RAS), including angiotensin-converting enzyme (ACE) inhibitors and angiotensin II type 1 receptor blockers, reduce proteinuria, slow the progression to ESRD, and even improve the kidney function more effectively than non-RAS inhibitor therapy, achieving disease regression in some cases [6] . Furthermore, in patients with diabetes, RAS inhibitors delay the onset of microalbuminuria, and ACE inhibitors may reduce the excess cardiovascular mortality associated with diabetes renal disease [7] . Nevertheless, a significant number of patients with CKD still progress to ESRD, highlighting the need for clinical trials that develop and test novel disease-specific treatments as add-on to the currently available renoprotective therapies. Recent advances in understanding the pathogenesis of kidney diseases have provided a strong rationale for novel therapeutic approaches to specific renal diseases that will hopefully address important unmet needs in the field [8] . Advances in renal medicine commonly rise from the Western countries and set their influence on the Eastern nations. Unfortunately, there are pitfalls in the current drug development paradigm in our countries, including in the design, conduct, and evaluation of clinical trials, which should raise awareness and not be repeated by Eastern countries. Issues of particular relevance to clinical trials in nephrology include the inappropriate use of Kidney Disease: A Global Health Problem