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American Journal of Kidney Diseases

Ten Years Atop the Masthead

      The December 2016 issue of AJKD is the 120th and final issue assembled by this editorial team and an appropriate time for reflection. Ten years ago, we stated that our goals were “to responsibly, professionally, and expediently deliver knowledge from researchers and practitioners to the wider community of nephrology and medicine, …to continue to improve the quality and the clinical relevance of AJKD, …and to make better use of the internet and our website.”
      • Levey A.S.
      • Weiner D.E.
      The challenges of the next 5 years.
      We believed that although our goals were ambitious, we had assembled an editorial team capable of accomplishing them.
      It is difficult to judge a journal’s performance. Metrics are imperfect, and rapid changes in medical publishing during the past 10 years, and in publishing in nephrology, created trends that are beyond the control of editors. We are now firmly ensconced in the age of instantly available information, and AJKD has balanced this with delivery of accurate and important knowledge.
      A brief review of the evidence suggests that AJKD has remained a vital and vibrant journal during our term. Readership has grown solidly. Comparing 2015 to 2007, the number of full-text accesses of AJKD articles on the various journal platforms has increased nearly 2.5-fold. During that same period, the number of subscribers to the e-mail table of contents alerts available via AJKD.org has jumped 8-fold. According to data from Thomson-Reuters, the total number of citations to AJKD articles has increased by 27%. Based on the projected number of manuscripts arriving in our final year, overall submissions have increased by 30% during the past decade despite the establishment of several new journals in nephrology with a similar mission as AJKD. Submissions of Original Investigations, the primary vehicle for dissemination of new research findings, have increased by 35%; the acceptance rate now stands at 12%. The region of origin of manuscripts has also changed dramatically. Although approximately 40% of submissions continue to be received from the Americas, the proportion from Asia-Pacific has increased by 35%. AJKD’s Impact Factor has increased from 3.981 in 2007 to 6.269 today, firmly establishing AJKD as the leading journal devoted exclusively to clinical research and practice in nephrology.
      In many ways, January 2007 was an inauspicious time to become journal editors. The year prior, the retraction by Science of 2 studies purporting to describe breakthroughs in human stem cell cloning focused public awareness on the limitations of peer review. Meanwhile, the controversy surrounding an apparent lack of transparency regarding the cardiovascular toxicity of rofecoxib (Vioxx) was playing out in the pages of the New England Journal of Medicine. A New York Times headline captured the spirit of the times: “For Science's Gatekeepers, a Credibility Gap.” However, although these high-profile failures in scholarly publishing likely permanently diminished the stature and prestige of journal editors, they also cemented the importance of these gatekeepers, who were perhaps best placed to promote and enforce the emerging recommendations for reporting research clearly and accurately.
      We believed that the best approach to improving quality was to ensure validity and transparency. At the beginning of our term, we introduced statistical review for all original research articles and focused on standards for reporting. We expanded AJKD’s information for authors to advocate use of consensus guidance on reporting of clinical trials (CONSORT), observational studies (STROBE), meta-analyses (QUORUM), and studies of diagnostic accuracy (STARD). To reduce the likelihood of misleading spin and to facilitate the activities of future meta-analysts, we developed structured abstract headings for each Original Investigation subtype. To improve the transparency of the editorial process, we drafted a conflict-of-interest policy for editors and established a detailed protocol to handle manuscripts arising from the editorial team. As new reporting guidance became available (PRISMA, CARE, CHEERS, and others), AJKD updated its information for authors to advocate their use. The journal became a member of Committee on Publication Ethics (COPE); delineated more fully its policies governing authorship, financial disclosure, and misconduct; and added information about peer review, as well as CrossMark versioning protection to its articles.
      In the early years, we worried that authors would consider AJKD’s somewhat lengthy revision letters and the specificity of our reporting requests to be symptomatic of editorial over-reach, and we were concerned about the time our review process took; however, we believed strongly that if research was worth publishing, it merited being presented in as accurate, clear, and complete a manner as possible. Years later, we gained some reassurance that we were on the right track when The Lancet published a series on research waste, and in an article about incomplete or unusable reports of studies, we saw that many of the activities AJKD pursued align with what the authors report are effective strategies. In particular, the authors describe that there is “some evidence of improvements in reporting with intensive editorial processes, provision of instructions to authors, and structuring of abstracts.”
      • Glasziou P.
      • Altman D.G.
      • Bossuyt P.
      • et al.
      Reducing waste from incomplete or unusable reports of biomedical research.
      The authors further noted that journals actively enforcing reporting guidelines had an improvement in the reporting of abstracts, which was not seen in journals merely endorsing the recommendations.
      At the same time, the scope of the research content considered by the journal was expanding. AJKD’s first quality improvement report appeared alongside an editorial acknowledging the many barriers to publication of such activities, but emphasizing the journal’s enthusiasm for their potential to improve clinical care. AJKD launched Research Letters as a venue for studies that might not have the scale necessary for a full-length research article, but that still contained an important clinical message; examples include pharmacodynamic studies to guide medication dosing in kidney disease and studies of the accuracy of glomerular filtration rate estimation equations. Recognizing the relevance of qualitative research to the growing prominence of efforts to enhance patient-centered care, AJKD recategorized qualitative research studies as fully fledged Original Investigations and endorsed the COREQ recommendations for reporting the conduct and findings of such efforts. The journal then turned the spotlight on clinical prediction models, encouraging submissions and advocating the use of the TRIPOD statement. Thus, while clinical trials and epidemiologic studies form the bulk of AJKD research articles, the journal’s evolution over the years has been a deliberate effort to reflect the full breadth of clinical research in nephrology, particularly as it relates to patients’ priorities and clinicians’ understanding of those goals.
      To address the goal of improving relevance, we believed that the best approach was through increasing educational features and maintaining a close alignment with the goals of the National Kidney Foundation (NKF). Our term saw the launch of additional teaching case types, a new editorial series, personal essays, and varied article types designed to review or comment on advances in nephrology. Our latest and most ambitious undertaking is the 2nd edition of the AJKD Atlas of Renal Pathology, led by Dr Agnes Fogo.
      • Fogo A.
      • Gilbert S.J.
      • Levey A.S.
      Introducing the AJKD Atlas of Renal Pathology II.
      Over the years, the journal doubled its education- and commentary-based content. This shift was a deliberate effort to cater to busy practitioners, with the intent of providing information on research developments in as accessible and clinically useful format as possible.
      During the 10 years of our term, NKF has continued its strong focus on clinical practice guidelines and public health. In celebration of the 10th anniversary of the KDOQI (Kidney Disease Outcome Quality Initiative) 2002 clinical practice guideline on chronic kidney disease (CKD), AJKD featured a series of commentaries from the US and international kidney communities on its impact. With the shift in guideline development to the international organization KDIGO (Kidney Disease: Improving Global Outcomes), AJKD began publishing commentaries by KDOQI on KDIGO guidelines. Through the years, AJKD published reports of NKF conferences and workshops with US governmental agencies on public health issues, including an NKF–Centers for Disease Control and Prevention workshop on comprehensive public health strategies for CKD and NKF–US Food and Drug Administration workshops on proteinuria as a surrogate outcome in CKD, glomerular filtration rate decline as an end point for clinical trials in CKD, and patient-reported outcomes in CKD. AJKD has continued its tradition of publishing the US Renal Data System Annual Data Report and added the data report of the US Peer Kidney Care Initiative (2015) and the inaugural Chinese Annual Data Report (expected publication 2017). In 2013, AJKD began a tradition of publishing articles contributed by NKF Presidents and Spring Clinical Meeting Awardees.
      To realize our aim of engaging readers in digital media, and recognizing the ever-changing world of communication and rapid information exchange, we introduced the AJKD blog (www.AJKDblog.org) in 2011. Led by Dr Kenar Jhaveri, this was the first blog launched by a major nephrology journal. The blog covers AJKD content, as well as other news and events that affect nephrologists, using timely posts, rapid commentary, and interactive features.
      • Desai T.
      • Sparks M.A.
      • Nair V.
      • et al.
      The state of the blog: the first year of eAJKD.
      In 2013, NephMadness was conceived by blog team members Drs Matt Sparks and Joel Topf as a learning module in the tradition of free open access medical education (FOAMed) to encourage deeper engagement by trainees and junior faculty. Modeled after the National Collegiate Athletic Association (NCAA) Basketball Tournament, colloquially known as March Madness, NephMadness replaces the usual field of basketball teams with concepts in nephrology, arranged in a tournament bracket.
      • Sparks M.A.
      • Lerma E.V.
      • Kupin W.
      • Phelan P.J.
      • Jhaveri K.D.
      • Topf J.
      NephMadness 2015: nephrology as a cornerstone of medicine.
      Participants are encouraged to tweet, blog, and promote their picks, resulting in a spirited exchange without distinctions between teacher and pupil.
      Twenty years ago, then outgoing AJKD Editor-in-Chief Dr Saulo Klahr remarked on the coming journal transition by noting that “with change comes freshness.”
      • Klahr S.
      From Eastern Missouri to West Texas.
      We share this belief and are confident that the enthusiasm and new perspectives of Dr Feldman’s Philadelphia-based team will spur the journal to greater prominence and influence. At the same time, we are glad that many constants will remain in place, from the steadfast support of NKF via the efforts of Dr Kerry Willis and her team, to the expert guidance of Executive Publisher Livia Berardi and colleagues at Elsevier, to the preservation of institutional memory made possible by the commitment of several editorial office staff to remain with the journal.
      While we have alluded to some of the most challenging moments in scholarly publishing in modern times, our over-riding experience with the journal has been a feeling of privilege to have been involved in its recent evolution. Though some of our decisions may have engendered the opposite response in authors and readers, this has been a labor of love and a decade of joy. Thousands of moments over the years—a Co-Editor finding the energy to read yet another revision of a manuscript with the same attentiveness and dedication as was accorded the initial submission, a member of the Editorial Board assuming the duties of Acting Editor in Chief, a Feature Editor soliciting and reviewing manuscripts on topics new and old, a NephMadness blogger deferring sleep to convey the elegance and allure of nephrology via basketball analogies, a member of the staff wearily opening her laptop to process manuscripts while on vacation—convey the import of this journal and its vast and engaged community to the Boston-based team. We are grateful to have been entrusted its care, and we look forward to watching it flourish in its new home.

      Acknowledgements

      Drs Levey, Weiner, Gilbert, and Dorman serve as Editor-in-Chief, Deputy Editor, Education Editor, and Managing Editor of AJKD, respectively.
      Financial Disclosure: The authors have received support from the NKF in furtherance of their editorial duties.

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