Group-based Chronic Kidney Disease Care

描述（由申请人提供）：慢性肾脏疾病在美国影响约2600万人，是一种进行性疾病，每年都有患者丧失肾功能。肾功能低下和肾功能下降都单独与心血管风险和进展相关，需要肾脏替代治疗。少数种族和族裔承受着不成比例的肾脏疾病及其并发症负担。唯一被证实的减缓慢性肾脏疾病进展的疗法之一是控制血压（BP），这是很难实现的。我们将从纽约布朗克斯区的儿科和成人慢性肾病诊所招募350名12岁及以上的慢性肾病患者，主要由非西班牙裔黑人和西班牙裔人组成。300名高血压未控制的成年受试者将参加一项随机临床试验，分为两组：1)常规治疗，每月进行CKD门诊就诊，包括

DESCRIPTION (provided by applicant): Chronic kidney disease affects approximately 26 million individuals in the United States and is a progressive disease, with individuals losing kidney function yearly. Low kidney function and decrements in kidney function are both individually associated with cardiovascular risk and progression to the need for renal replacement therapy. Racial and ethnic minorities suffer a disproportional burden of kidney disease and its complications. One of the only proven therapies to slow the progression of chronic kidney disease is control of blood pressure (BP) which is difficult to achieve. We will enroll 350 patients with chronic kidney disease aged 12 and older from pediatric and adult chronic kidney disease clinics in the Bronx, NY, a sample composed primarily of non-Hispanic blacks and Hispanics. The 300 adult participants with uncontrolled hypertension will participate in a randomized clinical trial with 2 arms: 1) usual care with monthly CKD clinic visits, including distribution of educational materials from the National Kidney Disease Education Program (NKDEP), or 2) distribution of educational materials from the NKDEP and monthly group-based visits with other patients with CKD in the CKD clinic to encourage medication adherence, dietary restrictions and physical activity. We hypothesize that participants randomized to 6 months of group-based care will show improvements in our outcome measurements including: 24-hour ambulatory BP monitoring, self-reported medication adherence, quality of life, patient satisfaction and 24-hour urine sodium levels and 7 day physical activity measured by pedometer at baseline and 6 months. The study is powered to detect a 5 mmHg difference in 24-hour mean systolic blood pressure between the intervention and usual care groups. The 50 adolescents recruited into the study will undergo the same educational and peer and provider support in group-based care as the adults. We will compare their 24-hour ambulatory blood pressures, missed appointments and dietary and physical activity adherence at the end of the 6 months to their baseline. This application brings together experts in kidney disease (Drs. Kaskel, Bauer, and Melamed) and behavioral interventions for chronic diseases (Drs. Bauman, Doyle and Litwin) to make a strong team poised to perform this research in an underserved, high-needs patient population.