KRESCENT;2005-2025 – 20 years! Editorial

The KRESCENT Program Rationale and History

The Kidney Research Scientist Core Education and National Training (KRESCENT) Program was created in response to the recognition by the Canadian research community of the rising prevalence of kidney disease, coupled with declining interest and engagement of trainees in kidney research. ¹ In November 1999, the Kidney Foundation of Canada (KFOC) and the Canadian Society of Nephrology (CSN) co-hosted the Horizons 2000+ conference, bringing together multiple stakeholders with the goal of developing strategies to enhance kidney research capacity and infrastructure in Canada. This was the first of a series of strategic planning meetings that resulted in the release of the National Research Coalition Task Force report in 2002, which contained the blueprint for a long-term strategy to build research capacity through productive partnerships and create a fertile environment for research excellence and innovation.

In the autumn of 2002, the CSN established an ad hoc Scientific Committee to address a diminished ability to attract and sustain kidney research scientists in Canada, barriers to translating scientific research knowledge to clinical practice and strategies for improving patient outcomes. With support from the CSN and KFOC, the committee organized 2 meetings in March and September 2003 that brought together a broad spectrum of leading biomedical, clinical, and allied health scientists from across Canada with representatives from KFOC and the Canadian Institutes of Health Research, Institute of Nutrition Metabolism and Diabetes (CIHR-INMD). These meetings resulted in all parties committing to an exciting new training program for kidney research scientists, which was financially supported by the KFOC, CSN, CIHR-INMD, and private sector stakeholders.

The launch of the KRESCENT Program in 2004, with the first trainees starting in 2005, was a testimony to the leadership of the individuals, organizations, and companies committed to reducing the burden of kidney disease throughout Canada. Since its beginning, the purpose of the KRESCENT Program has been (1) to enhance capacity in kidney research in Canada, (2) to foster collaboration and networking between Canadian kidney researchers, and (3) to ensure knowledge translation from fundamental discovery to improved outcomes of Canadians and their families living with kidney disease. ²

The KRESCENT program funded 3 categories of individuals; postdoctoral fellows (PDFs), New Investigators (those in the first 3 years of a faculty appointment) and allied health professionals but also did more. Several elements of the KRESCENT Program were novel at the time of its inception, notably the inclusion of trainees spanning multiple research pillars, including allied health professionals, non-MD PhD researchers as well as MD researchers; the salary support for trainees was substantially higher than the national average, the program provided start-up funds for New Investigators; and a national core curriculum of kidney-related topics delivered via twice-yearly mandatory in-person workshops. These immersive, experiential learning workshops brought trainees, mentors, and established kidney scientists across Canada together for 2 work-intensive days. Trainee feedback and continued success^2,3 spanning 20 years have unequivocally established the pivotal role that this immersive training environment has had in fostering a culture of collaborative research and knowledge translation across research themes, forging lasting friendships among trainees, and in facilitating networking opportunities with kidney scientists from across the country. The diverse experiences and areas of research study exchanged in a supportive environment and in the context of ongoing learning and growth continue to make the program unique and successful.

Other pillars of the KRESCENT Program include mentorship from the Canadian community outside the trainees’ local environment; emphasis on career development at the postdoctoral level and in the new investigator period following the candidate’s first faculty appointment; peer-review training in collaboration with the Canadian Journal of Kidney Health and Disease (CJKHD); and regular trainee feedback that has continually reshaped the curriculum to best align with trainee needs. Together, these elements of the core curriculum offered dynamic learning opportunities not available in any other forum or location at that time.

Capacity Building 2005-2018

Over the course of its 20-year history, the KRESCENT Program has evolved to be complementary to core coursework/degree programs in research design, methodology, and other core content areas available at the trainee’s institution. The curriculum was developed based on principles of adult learning and employed varied methods. A combination of didactic teaching, workshops, and skill enhancement is offered at each workshop. Trainees present their own work and research programs, participate in roundtable discussions, grant and manuscript review sessions, and learn about specific aspects of kidney disease including acute kidney injury (AKI), chronic kidney disease (CKD), hypertension, tubulopathies, glomerular disease, dialysis, transplantation, organ donation, and kidney failure. This exposure to methodology and content for all trainees, irrespective of background or primary interest, was intentional as it promotes team building, knowledge translation as well as provides a breadth of knowledge across research disciplines. The curriculum also includes opportunities for honing skills in delivering effective presentations, chairing sessions, and writing supportive grant, and manuscript reviews.

Since its inception, the evolution of the KRESCENT curriculum has been largely driven by the trainee’s voice. Ongoing trainee feedback has profoundly reshaped the core curriculum over 20 years, ensuring the program aligns with trainee needs in a rapidly evolving kidney research culture and the broader national research context. In 2015, a more formal relationship was established with the CJKHD, under the leadership of the Editor in Chief, Dr. Catherine Clase, at the behest of KRESCENT trainees. The formalization of this relationship has become an important ongoing component of program growth. The editorial leadership of CJKHD committed to providing mentorship in the principles of supportive peer review at KRESCENT spring workshops ⁴ and officially began recognizing KRESCENT trainees as members of the CJKHD Editorial Board, which served an additional value, as it contributes to the trainee’s Curriculum Vitae as a recognized activity. In addition, CJKHD offered 2 waivers per year into perpetuity for first-year KRESCENT trainee-led team manuscript reviews addressing translational themes in kidney health and disease, an exercise called the transdisciplinary research (TDR) Challenge. Trainees are grouped into intentionally varied backgrounds, an approach that through experiential learning, helps develop scientific multilingualism. KRESCENT mentors provide internal peer review, before manuscript submission to CJKHD for external peer review. There have been 13 trainee publications in CJKHD as of 2025, with 2 currently undergoing peer review.

The KRESCENT program’s core curriculum is delivered through 3 different educational formats:

1. A formal core lecture series, (knowledge acquisition modules), delivered at twice-yearly workshops led by the KRESCENT Leadership and Mentors.

2. Web-based exercises (knowledge application and knowledge integration modules).

3. TDR challenges held once a year at the May workshop that are linked to the skills acquired and applied in the core lecture series and web-based exercises.

With the increasing importance of patient-oriented research, formalizing the involvement of patients in the KRESCENT program commenced in 2016, concomitant with the formation of CAN-SOLVE CKD (CIHR pan-Canadian funded Patient-Oriented Research Network). This has proven to be another invaluable addition to the program, especially meaningful for the basic and translational scientists who may have limited access to patients. Patient involvement began with invited individuals sharing their lived experiences at workshops. Over time, patient involvement has become more formalized with establishing the patient community advisory network (PCAN in 2022). In addition to sharing the lived experience, PCAN members now provide input into the organization of biannual meetings, reviewing applications to the program, ⁵ crucial feedback on lay summaries for both grants and journal articles, and report on scientific presentations. Recently PCAN members have also served as co-authors on first-year trainee TDR manuscripts submitted to CJKHD.^{6 -9}

Another novel essential aspect of the KRESCENT program is a built-in mentoring system that facilitates career development outside the trainees’ institutional environment. Trainees interact with the Program Director, Curriculum Chair, Senior Consultant and invited senior scientists twice a year in a collaborative career development workshop setting. The program director, curriculum chair, and senior consultant also hold annual one-on-one meetings with trainees to review successes, concerns, and other issues. KRESCENT mentorship serves to complement (not replace or over-ride) existing local supervisory mentorship available at trainee host institutions. Arms-length “unbiased” advice and mentoring support provided by the KRESCENT Program has been particularly welcomed by trainees during times of uncertainty, or when issues have arisen with institutional or supervisor support.

In addition, at the discretion of New Investigator trainees, the KRESCENT Program facilitates the establishment of formal “level-specific” mentorship with an external Program Mentor. KRESCENT also provides ongoing support for this mentorship. KRESCENT mentors offer agnostic, unbiased feedback on career planning, job negotiation, and serve to increase opportunities for collaboration.

KRESCENT Program Outcomes

The success of the KRESCENT program, conceptualized in 2000, and launched in 2005, was reviewed in 2021 to support an application for increased funding from CIHR via a Health Research Training Platform (HRTP) grant application. Updated and more detailed program outcomes are presented in separate manuscripts in this 20th anniversary issue. Some significant program outcomes are worthy of note. As of 2020, 99 awards were allocated to 76 trainees (N.B. 23 New Investigators were initially funded as PDFs) across the 3 training pathways. More than 50% of funded trainees were female (53%). Forty-eight of the 76 research trainees (63%) have secured an academic position in a Canadian Institution, working in all 4 CIHR research themes. Importantly, the gender of the KRESCENT awardee did not affect the likelihood of obtaining an academic position. ¹⁰ Furthermore, when assessing the likelihood of KRESCENT awardees to be promoted to associate professor, women were as likely as men to be promoted in contrast to the literature which reports women being less likely to be promoted through the academic ranks.^10,11 Of the KRESCENT trainees that did not pursue academic positions, some have become entrepreneurs with start-up companies, others have careers in industry or careers in the not-for profit sector. KRESCENT trainees have been remarkably successful with grant funding; 70% of awardees have secured national-level funding from either CIHR, the KFOC, or both.

Participants cite that formalizing patient engagement in the KRESCENT program, through the establishment of PCAN, is an important and indeed invaluable component. Trainees have also noted the importance of the relationship with CJKHD in providing exposure to manuscript review processes, supportive peer review, and increased exposure to colleagues across Canada.

A New Director and the Health Research Training Pilot Grant: 2018-2024

The original director (Kevin Burns) stepped down in 2017 and was replaced by former KRESCENT awardee Todd Alexander (2007-2009 PDF, 2009-2012 NI) in 2018. Sunny Hartwig, another KRESCENT awardee (2006-2009 PDF, 2010-2013 NI), replaced Adeera Levin as the Curriculum chair. Dr. Levin remained in an advisory capacity to ensure the transition of knowledge and to help continue to drive the success of the program.

Around this time, CIHR started to withdraw its financial support for the KRESCENT Program, in earnest of the imminent launch of a competitive funding opportunity entitled the HRTP pilot platform (CIHR HRTP). The application process for the CIHR HRTP grant was delayed by the COVID-19 pandemic that struck in 2020. In addition to reduced funding, the KRESCENT Program went online during the ensuing years. Amidst the uncertainties of the pandemic, the ability of the KRESCENT Program to continue to provide its unique arm of mentorship to trainees without disruption highlighted a great strength of the program, namely, the peer-peer mentorship and community support that became a touchstone for many during the upheaval of COVID.

During this time, the HRTP grant application became another positive, unifying force in the kidney community as stakeholders from across Canada took part in multiple virtual meetings to strategize for the HRTP application. Under the leadership of the KRESCENT Director (Nominated Principal Applicant (NPA) of the grant), a core team of investigators and a writing group were assembled. Administrative support provided by Program Manager Dr. Jenn Klein, strategic planning with other HRTP NPAs and peer review provided by Dr. Robb Quinn were invaluable in securing success amidst a novel application process fraught with evolving requirements, density of language, and unclear expectations.

The KRESCENT Program was 1 of 13 inaugural HRTPs to be funded, and 1 of 3 supported by the Institute of Nutrition Metabolism and Diabetes. Through this opportunity, CIHR funding of the program increased from $200,000 to $400,000 per annum. Importantly, this also provided dedicated funds for the involvement of patients with the program. We were thus able to increase the patient advisory group, PCAN from 4 to 6 members.

Other noteworthy changes to the program that arose from this period included a renewed emphasis on wellness and team-building activities at in-person meetings, and a focus on addressing the paucity of black and Indigenous kidney health researchers in Canada despite the increased incidence of kidney disease and poorer outcomes in these populations.^{12 -15} To that end, a summer studentship program was launched in 2023, providing salary support for undergraduate or medical school students identifying as Black or Indigenous to complete a summer student position in a culturally safe kidney research environment. To date, 3 summer students have graduated through the KRESCENT summer studentship program (2 medical students, 1 third-year undergraduate student), and all 3 have been invited to present their work at the annual meetings of the CSN or the American Society of Nephrology. Key components of the KRESCENT training program are listed in Figure 1.

Figure 1.

KRESCENT training offerings.

The Next 20 Years, 2025 and Beyond

After a search and selection procedure by the key stakeholders, Mathieu Lemaire (also a prior KRESCENT trainee; 2011-2014 PDF, 2017-2020 NI, Figure 2), was appointed director in November 2024. The ongoing development and growth of research in kidney diseases in Canada will no doubt be influenced by the breadth and depth of the KRESCENT “graduates” over the last 20 years and their ability to support the ongoing growth of the next generation.

Figure 2.

Timeline.

KRESCENT, the acronym and name chosen to signify “new beginnings,” continues to invent and re-invent itself based on the changing research environment in Canada and worldwide. Our graduates, who now hold important research and leadership positions in almost every province, continue to commit time and energy to the program, as a way to “pay it forward.”

The Kidney Research Scientist and Education Training Program is a first-in-kind, integrated research scientist “incubator.” We believe the next 20 years look as promising as the last for the continued training of high-caliber kidney research scientists in Canada.