Modifiable and Biochemical Predictors and Consequences of Acute Kidney Injury

急性肾损伤的可修改和生化预测因子及后果

• 批准号: 8666747
• 负责人: Amanda Hyre Anderson
• 金额: $ 13.63万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8666747
• 关键词: Acceleration; Achievement; Acute Renal Failure with Renal Papillary Necrosis; Award; Biochemical; Body mass index; Businesses; Cardiovascular Diseases; Cardiovascular system; Chronic; Chronic Kidney Failure; Chronic Kidney Insufficiency; Cohort Studies; Communities; Comorbidity; Cox Proportional Hazards Models; Data; Data Set; Development Plans; Disease Progression; Diuretics; Doctor of Philosophy; Drug usage; End stage renal failure; Environment; Epidemiology; Faculty; Fellowship; Funding; Glomerular Filtration Rate; Goals; Growth; Homocysteine; Homocystine; Hospitalization; Hypotension; Individual; Inflammatory; Injury; Interleukin-6; Intervention; Investigation; Kidney; Kidney Diseases; Knowledge; Leadership; Liver Failure; Measures; Mentored Research Scientist Development Award; Mentors; Modeling; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; National Research Service Awards; Nephrology; Non-Steroidal Anti-Inflammatory Agents; Outcome; Participant; Pennsylvania; Positioning Attribute; Postdoctoral Fellow; Program Development; Proteins; Renal function; Renin-Angiotensin System; Reporting; Research; Research Infrastructure; Research Personnel; Research Project Grants; Resources; Risk; Risk Factors; Schools; Scientist; Septicemia; Severities; Severity of illness; Source; Statistical Methods; Structural Models; Time; Training; Universities; Update; adverse outcome; base; blood pressure regulation; cardiovascular disorder risk; career; career development; cohort; community setting; epidemiology study; experience; follow-up; glycemic control; improved; inflammatory marker; innovation; medical schools; member; modifiable risk; mortality; population based; programs; urinary

DESCRIPTION (provided by applicant): In this proposal for a Mentored Research Scientist Development Award (K01), Amanda Hyre Anderson, PhD, MPH, outlines her career goals, career development plan, environment, mentoring framework, and research project to examine modifiable and biochemical predictors and consequences of acute kidney injury (AKI) in chronic kidney disease (CKD). Dr. Anderson completed her master's and doctoral training in Epidemiology at Tulane University with numerous awards and honors, and finished a NRSA postdoctoral fellowship in Renal Epidemiology at the University of Pennsylvania School of Medicine. She is currently a Research Associate at Penn and a co-investigator on the Chronic Renal Insufficiency Cohort (CRIC) Study. Dr. Anderson plans to pursue a career as an independent investigator to study the epidemiology of AKI in CKD, characterization and prediction of kidney function decline over time, and insufficiently examined co-morbidities and outcomes (e.g., non-cardiovascular co-morbidities) associated with CKD. Her long-term goal is to hold a standing faculty position as an active investigator. To enable her transition from mentored scientist to independent investigator during the award period, Dr. Anderson will 1) seek an improved knowledge of renal disease through coursework and nephrology rounds, 2) pursue an expanded repertoire of sophisticated statistical methods through coursework and mentoring, 3) strengthen her leadership capabilities by completing a leadership development program through the Wharton School of Business and engaging in CRIC Study oversight activities, 4) leverage interactions with mentors and consultants to refine her research plan and support her career development, and 5) submit an R01 application to further her independent research program. The overall goal of the proposed K01 research project is to identify modifiable and biochemical risk factors for AKI, and to examine the impact of AKI on morbidity and mortality among a diverse group of extremely well- characterized CRIC participants with CKD. More specifically, the aims of the project are: 1) to examine poor glycemic control, inadequate control of blood pressure, elevated body mass index, and use of renin- angiotensin-system blockade, diuretics, and nonsteroidal anti-inflammatory drugs as modifiable risk factors for AKI in the setting of CKD, 2) to investigate inflammatory and kidney injury markers, as well as CKD severity, as risk factors for AKI in CKD, and 3) to examine the impact of AKI on subsequent mortality and morbidity in CKD. All proposed investigations will occur within the cohort framework of the CRIC Study utilizing Cox proportional hazards models, mixed effects growth curve models, and marginal structural models with time-updated exposures. An innovative mixed effects approach will be employed among CRIC participants who experience AKI during follow-up to compare the slope of kidney function decline before and after the AKI episode. This study will make possible the identification of potentially modifiable, and thus, clinically-actionable, risk factors for AKI, and improve our understanding of the impact of AKI on the course of CKD.

描述（由申请人提供）：在指导研究科学家发展奖 (K01) 的提案中，Amanda Hyre Anderson 博士、公共卫生硕士概述了她的职业目标、职业发展计划、环境、指导框架和研究项目，以检查慢性肾病 (CKD) 中急性肾损伤 (AKI) 的可修改和生化预测因素及后果。安德森博士在杜兰大学完成了流行病学硕士和博士培训，并获得了众多奖项和荣誉，并在宾夕法尼亚大学医学院完成了 NRSA 肾脏流行病学博士后奖学金。她目前是宾夕法尼亚大学的研究员，也是慢性肾功能不全队列 (CRIC) 研究的联合研究员。 Anderson 博士计划成为一名独立研究者，研究 CKD 中 AKI 的流行病学、肾功能随时间下降的特征和预测，以及与 CKD 相关的合并症和结果（例如非心血管合并症）的检查不充分。她的长期目标是作为一名积极的调查员担任常设教职。为了使她能够在获奖期间从受指导的科学家转变为独立研究者，安德森博士将 1) 通过课程作业和肾脏病学查房寻求提高对肾脏疾病的了解，2) 通过课程作业和指导来扩展复杂的统计方法，3) 通过完成沃顿商学院的领导力发展计划并参与 CRIC 研究监督活动来增强她的领导能力，4) 利用与导师和专家的互动 顾问完善她的研究计划并支持她的职业发展，5) 提交 R01 申请以进一步推进她的独立研究计划。拟议的 K01 研究项目的总体目标是确定 AKI 的可改变的生化危险因素，并检查 AKI 对特征极其明确的 CRIC 慢性肾病参与者的发病率和死亡率的影响。更具体地说，该项目的目标是：1) 检查血糖控制不良、血压控制不充分、体重指数升高，以及使用肾素-血管紧张素系统阻断剂、利尿剂和非甾体抗炎药作为 CKD 背景下 AKI 的可改变危险因素，2) 调查炎症和肾损伤标志物以及 CKD 严重程度作为风险 CKD 中 AKI 的影响因素，以及 3) 检查 AKI 对 CKD 中后续死亡率和发病率的影响。所有拟议的调查都将在 CRIC 研究的队列框架内进行，利用 Cox 比例风险模型、混合效应增长曲线模型和具有时间更新暴露的边际结构模型。将在随访期间经历 AKI 的 CRIC 参与者中采用创新的混合效应方法，以比较 AKI 发作前后肾功能下降的斜率。这项研究将有助于识别 AKI 的潜在可改变的、临床上可操作的危险因素，并提高我们对 AKI 对 CKD 病程影响的理解。