Impact of Cardiovascular Risk Control on Racial Disparities in Kidney Transplant

描述（由申请人提供）：申请人的长期目标是成为一名独立研究者，设计和执行研究以优化肾移植患者的药物利用，具体目标是减少移植物存活率的种族差异。黑人肾移植受者在肾移植后移植物丢失的风险显著更高，部分原因是公认的免疫高反应性，较差的社会经济地位和更严重的共病状况。以前减少黑人受者差异的许多干预措施都集中在改善移植的可及性和降低免疫风险上;然而，黑人和非黑人肾移植患者之间移植物存活率的差异并没有显着改善。迄今为止，很少有人关注改善CVD危险因素控制作为减少肾移植种族差异的潜在方法。拟议的研究计划将试图通过一项两阶段研究来验证CVD风险因素控制显著影响肾移植结局种族差异的假设。第一阶段：一项使用国家数据集（VA、CMS和USRDS）进行的大规模纵向队列研究，批判性地分析了CVD风险因素控制对肾移植种族差异的影响。第二阶段：C-DRIFT试验（肾移植中的心血管疾病风险因素控制）是一项前瞻性研究，旨在探索药师主导的患者水平干预措施的可行性和潜在有效性，这些干预措施旨在改善CVD风险因素控制，作为减少肾移植受者种族差异的机制。完成这些研究将提供新的和令人信服的初步数据，因此，在本奖项结束时，将提交一份赠款提案，以进行一项大规模随机对照试验，以检验优化CVD风险因素控制将改善肾移植患者的移植物存活率和种族差异的假设。此外，同样重要的是，这笔赠款的完成将为申请人提供宝贵的培训和指导，使他能够发展成为独立资助的调查员所需的技能。拟议的职业发展计划利用了丰富的跨学科合作环境，独特的患者群体， 以及南卡罗来纳州医科大学提供的综合教学课程。该申请的主要导师和共同导师是经验丰富且资金充足的研究人员，他们在种族差异，肾移植和CVD干预研究方面具有专业知识。因此，在该奖项结束时，将产生和传播有关CVD风险因素控制对肾移植种族差异影响的新数据，同时申请人发展成为训练有素的研究人员，能够在肾移植受者中进行相关的以患者为导向的研究。

DESCRIPTION (provided by applicant): The long-term goal of the applicant is to become an independent investigator who designs and executes studies to optimize medication utilization in kidney transplant patients, with the specific goals of reducing racial disparities in graft surviva. Black renal transplant recipients are at significantly higher risk for graft loss following kidney transplant due, in part, to well recognized immunologic hyper-responsiveness, poorer socioeconomic status and more severe comorbid conditions. Much of the previous interventions to reduce disparities in Black recipients have focused on improving access to transplant and reducing immunologic risks; yet the differences in graft survival rates between Black and non-Black kidney transplant patients have not significantly improved. To date, little attention has been directed towards improving CVD risk factor control as a potential approach to reduce racial disparities in kidney transplant. The proposed research plan will seek to test the hypothesis that CVD risk factor control significantly influences racial disparities in kidney transplant outcomes through a two phase study. Phase 1: a large-scale longitudinal cohort study conducted using national datasets (VA, CMS, and USRDS) that critically analyzes the modifying impact of CVD risk factor control on racial disparities among kidney transplants. Phase 2: The C-DRIFT trial (Cardiovascular Disease Risk Factor Control in Kidney Transplant) is a prospective study to explore the feasibility and potential effectiveness of pharmacist-led patient-level interventions directed at improving CVD risk factor control as a mechanism to reduce racial disparities in kidney transplant recipients. Completing these studies will provide novel and compelling preliminary data, so that by the conclusion of this award, a grant proposal will be submitted to conduct a large-scale randomized controlled trial powered to test the hypothesis that optimizing CVD risk factor control will improve graft survival and racial disparities in kidney transplant patients. Additionally and equally as important, the completion of this grant will provide the applicant invaluable training and mentoring that will allow him to develop the skillset necessary to become an independently funded investigator. The proposed career development plan capitalizes on the rich interdisciplinary collaborative environment, the unique patient population, and the comprehensive didactic coursework available at the Medical University of South Carolina. The primary mentor and co-mentors on this application are highly experienced and well-funded researchers that have expertise in conducting research in racial disparities, kidney transplant and CVD interventional studies. Thus, at the conclusion of this award, novel data regarding the impact of CVD risk factor control on racial disparities in kidney transplant will be produced and disseminated while the applicant develops into a well-trained researcher, capable of conducing relevant patient-oriented research in kidney transplant recipients.