Towards optimizing care for cardiovascular disease in chronic kidney disease

优化慢性肾脏病心血管疾病的护理

• 批准号: 8723184
• 负责人: Tara I-Hsin Chang
• 金额: $ 18万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-20 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8723184
• 关键词: Age; Antihypertensive Agents; Award; Blood Pressure; California; Cardiovascular Diseases; Cardiovascular system; Caring; Cause of Death; Cessation of life; Characteristics; Chronic Kidney Failure; Clinical; Clinical Investigator; Clinical Research; Data; Data Sources; Databases; Dialysis procedure; Discrimination; Disease Progression; End stage renal failure; Epidemiologist; Event; Funding; Future; Goals; Heart Diseases; Hemodialysis; Hypertension; Information Systems; Integrated Health Care Systems; Intervention Trial; Kidney; Kidney Diseases; Knowledge; Length; Light; Link; Measurement; Mediating; Mentored Patient-Oriented Research Career Development Award; Methods; Metric; Morbidity - disease rate; Obstructive Sleep Apnea; Outcome; Patients; Peripheral Vascular Diseases; Persons; Pharmaceutical Preparations; Phase; Population; Provider; Recording of previous events; Renin-Angiotensin System; Research; Research Personnel; Resources; Risk; Risk Factors; Risk Marker; Series; Smoking; Stress; Stroke; Sum; Testing; Time; Training; Ultrafiltration; United States; Variant; Visit; Waist-Hip Ratio; Work; adverse outcome; cardiovascular risk factor; career; career development; cohort; comparative effectiveness; compare effectiveness; experience; high risk; hypertensive heart disease; improved; indexing; inhibitor/antagonist; innovation; insight; medication compliance; modifiable risk; mortality; novel; patient oriented; patient population; prognostic; public health relevance; skills; waist circumference

DESCRIPTION (provided by applicant): The purpose of this K23 proposal is to provide Tara I. Chang, MD, MS with the protected time and resources to allow her to pursue the additional training needed to reach her long-term goal of becoming an independent patient-oriented investigator. Dr. Chang is a board-certified nephrologist and trained epidemiologist, and her research focuses on the intersection of cardiovascular disease and chronic kidney disease (CKD). Chronic kidney disease confers an increased risk for cardiovascular morbidity and mortality, and cardiovascular disease is the leading cause of death in CKD. Visit-to-visit blood pressure variability (BPV), defined as variation in blood pressure that occurs over days to months, is emerging as an important risk factor for death and cardiovascular events independent of mean or usual blood pressure in patients without CKD. Relatively little is known about visit-to-visit BPV in patients with CKD, a population at high risk for adverse clinical event. In addition, to date there is no uniform metric used to characterize visit-to-visit BPV. This projet proposes a series of analyses in patients with CKD, including end-stage renal disease (ESRD), to close some of the evidence gaps related to determinants and consequences of visit-to-visit BPV in this population. The specific aims of this project are to define the best metrics of visit-t-visit BPV; better characterize traditional and patient-centered determinants of visit-to-visit BPV; compare the effectiveness of antihypertensive medications on clinical outcomes and evaluate whether differences are mediated by differences in visit-to-visit BPV; and evaluate the incremental prognostic value of visit-to-visit BPV as a novel risk marker beyond systolic, diastolic, or mean arterial blood pressure. The proposed work has high potential to make a significant clinical impact, as completion of the project aims will not only advance the current understanding of visit-to-visit BPV in CKD, but also provide preliminary data on putative risk factors to target in a future intervention trial aimed at lowering visit-to-visit BPV and improving clinical outcomes. Importantly, the proposed work is realistic and feasible within the award period, and will allow Dr. Chang to continue to build research skills, generate preliminary data, create additional collaborative networks, and compete for R01 funding. In summary, the K23 award will support the proposed training and career development activities to allow Dr. Chang to launch successfully into the next phase of her career as an independent clinical investigator.

描述（由申请人提供）：本K23提案旨在提供塔拉I。Chang，MD，MS，有受保护的时间和资源，使她能够接受额外的培训，以实现她成为一名独立的以患者为导向的研究者的长期目标。Chang博士是一名经过委员会认证的肾病学家和训练有素的流行病学家，她的研究重点是心血管疾病和慢性肾脏病（CKD）的交叉点。慢性肾脏疾病增加了心血管发病率和死亡率的风险，心血管疾病是CKD死亡的主要原因。访视间血压变异性（BPV），定义为在数天至数月内发生的血压变化，正在成为无CKD患者死亡和心血管事件的重要风险因素，与平均或平时血压无关。对于CKD患者（不良临床事件高风险人群）的访视间BPV了解相对较少。此外，到目前为止，还没有统一的指标用于表征访视间BPV。该项目提出了一系列CKD患者（包括终末期肾病（ESRD））分析，以弥补该人群中访视间BPV的决定因素和后果相关的证据缺口。该项目的具体目标是定义访视-访视BPV的最佳指标;更好地表征访视-访视BPV的传统和以患者为中心的决定因素; 比较抗高血压药物对临床结局的有效性，并评价访视间BPV差异是否介导了差异;并评价访视间BPV作为收缩压、舒张压或平均动脉压以外的新风险标志物的增量预后价值。拟议的工作具有产生重大临床影响的高潜力，因为项目目标的完成不仅将促进目前对CKD访视间BPV的理解，而且还将提供关于假定风险因素的初步数据，以在未来旨在降低访视间BPV和改善CKD的干预试验中瞄准。 临床结果。重要的是，拟议的工作在奖励期内是现实可行的，并将使张博士能够继续培养研究技能，生成初步数据，创建额外的合作网络，并争取R 01资金。总之，K23奖将支持拟议的培训和职业发展活动，使Chang博士能够成功地进入她作为独立临床研究者的职业生涯的下一阶段。