Towards optimizing care for cardiovascular disease in chronic kidney disease

描述（由申请人提供）：本K23提案的目的是为Tara I. Chang， MD， MS提供受保护的时间和资源，使她能够进行额外的培训，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博士是一名经过认证的肾病专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疾病（CKD）的交叉。慢性肾脏疾病会增加心血管疾病的发病率和死亡率，而心血管疾病是CKD患者死亡的主要原因。就诊间血压变异性（BPV），定义为发生在数天至数月的血压变化，正在成为非CKD患者中独立于平均或正常血压的死亡和心血管事件的重要危险因素。相对而言，对于CKD患者的就诊-就诊BPV知之甚少，这是一个不良临床事件高风险人群。此外，到目前为止，还没有统一的度量标准来描述每次访问的BPV。该项目提出了一系列CKD患者的分析，包括终末期肾病（ESRD），以弥补与该人群中就诊-就诊BPV的决定因素和后果相关的一些证据差距。该项目的具体目标是定义访问-访问-访问BPV的最佳指标；更好地表征传统的和以患者为中心的就诊-就诊BPV决定因素；

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.