Impact of Cardiovascular Risk Control on Racial Disparities in Kidney Transplant

描述(由申请者提供)：申请者的长期目标是成为一名独立的调查者，设计和执行优化肾移植患者药物利用的研究，具体目标是减少移植肾存活率的种族差异。黑人肾移植受者肾移植后移植物丢失的风险明显更高，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。以前许多旨在减少黑人受者差异的干预措施都侧重于改善获得移植的机会和降低免疫风险；然而，黑人和非黑人肾移植患者之间的移植物存活率差异并未得到显着改善。到目前为止，很少有人将改善心血管疾病危险因素控制作为减少肾移植中种族差异的潜在方法。拟议的研究计划将通过两个阶段的研究来检验这一假设，即心血管疾病风险因素控制显著影响肾移植结果的种族差异。阶段1：使用国家数据集(VA、CMS和USRDS)进行的大规模纵向队列研究，严格分析心血管疾病风险因素控制对肾移植患者种族差异的修正影响。第二阶段：C-DRIFE试验(肾脏移植中的心血管疾病风险因素控制)是一项前瞻性研究，旨在探索药剂师领导的患者水平干预的可行性和潜在有效性，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一种机制。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，旨在测试优化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，这笔补助金的完成将为申请人提供宝贵的培训和指导，使他能够发展成为一名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协作环境、独特的患者群体、 以及南卡罗来纳医科大学提供的综合教学课程。这一应用程序的主要导师和联合导师是经验丰富且资金充足的研究人员，他们在进行种族差异、肾脏移植和心血管疾病干预研究方面具有专业知识。因此，在该奖项结束时，将产生和传播有关心血管疾病风险因素控制对肾移植中种族差异的影响的新数据，同时申请者将发展成为一名训练有素的研究人员，能够在肾移植接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.