Refining repeat screening for coronary artery disease in kidney transplant candidates

完善肾移植候选者冠状动脉疾病的重复筛查

• 批准号: 10189578
• 负责人: Xingxing Shelley Cheng
• 金额: $ 16.57万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10189578
• 关键词: Accreditation; Age; Award; Cardiac; Cardiopulmonary; Caring; Characteristics; Chronic Kidney Failure; Clinical; Clinical Investigator; Coronary Arteriosclerosis; Diabetes Mellitus; Effectiveness; Eligibility Determination; Evaluation; Event; Frequencies; Funding; Future; Goals; Grant; Guidelines; Healthcare; Heterogeneity; Hybrids; Information Systems; Institution; Intervention; Intervention Trial; Kidney; Kidney Transplantation; Knowledge; Lead; Machine Learning; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Modeling; Outcome; Patients; Performance; Phase; Physical Performance; Population; Process; Quality-Adjusted Life Years; Research; Risk; Risk Factors; Science; Specificity; Sum; System; Testing; Time; Training; Transplant Recipients; Transplantation; United States; Vision; Wait Time; Waiting Lists; Walking; Work; analytical method; base; career; clinical practice; clinical risk; cohort; comparative effectiveness trial; cost; design; experience; fitness; follow-up; high risk; improved; innovation; older patient; patient oriented research; patient subsets; personalized strategies; predictive test; prognostic value; prospective; recruit; relative effectiveness; response; risk stratification; screening; skills

7. Project Summary This K23 proposal will provide Xingxing S. Cheng, MD, MS with the protected time, mentorship, training, and research experience to become an independent clinical investigator. Dr. Cheng is a board-certified nephrologist and accredited transplant nephrologist, with a long-term vision of improving the effectiveness of health care for kidney transplant patients. She seeks to combine patient-oriented research and decision science to find innovative solutions to clinical problems. Skills she will acquire in this grant, under the guidance of a strong mentorship team, include 1) integration of patient-oriented research and decision analytic models; 2) assessing the heterogeneity of response in different patient subgroups; and 3) advanced modelling skills. This grant proposes to refine the process of screening of coronary artery disease in patients with chronic kidney disease on the wait-list awaiting kidney transplantation. Currently, patients undergo repeat cardiac screening tests at frequent intervals, few of which result in interventions. These tests impose a high treatment burden on patients and potentially delay time to transplant, while bringing unclear benefit to the patient. This grant proposes to refine the cardiac screening strategy and personalize it for specific patient subgroups (e.g. elderly patients with diabetes mellitus). It will examine strategies that vary the frequency of cardiac testing and risk stratification for cardiac testing based on a simple, inexpensive, and non-invasive test that can be performed in routine clinical settings, a 6-minute walk test (6MWT). This project will achieve this broad aim by three specific aims: 1) to characterize the 6MWT in identifying low-risk patients who do not additional cardiac testing; 2) to model strategies varying the frequency of cardiac testing and use of 6MWT; 3) to design strategies personalized for specific patient subgroups and model them in the entire kidney transplant candidate population of the United States (US). The first two aims will arise from a well-characterized cohort of patients at Dr. Cheng’s institution. Machine-learning systems will be used to identify which patient subgroups are best served by which strategies (i.e. the heterogeneity of response). The third aim will leverage the US Renal Data System, which Dr. Cheng’s mentors and institution has a track record of leveraging for innovative research. The proposed work has high potential to make a significant clinical impact. Its completion will enable the identification and characterization of rational strategies for pre-transplant screening of coronary artery disease that may be incorporated into clinical practice or pave the way for a future multi-center comparative effectiveness trial. The proposed work is realistic and feasible within the award period, and will allow Dr. Cheng to build research skills, advance and disseminate scientific knowledge, create additional collaborative networks, and compete for R01 or equivalent funding. In summary, the K23 award will provide the support to enable Dr. Cheng to become a successful independent clinical investigator.

7。项目摘要 该K23提案将为Xingxing S. Cheng，MD，MS提供受保护的时间，训练，培训和 研究经验成为独立的临床研究者。 Cheng博士是董事会认证的 肾脏科医生和认可的移植肾脏科医师，长期愿景是提高有效性 肾脏移植患者的医疗保健。她试图结合面向患者的研究和决定 科学找到临床问题的创新解决方案。根据指导，她将在这笔赠款中获得的技能 一个强大的心态团队，包括1）整合以患者为导向的研究和决策模型； 2）评估不同患者亚组反应的异质性； 3）高级建模技巧。 这项批准提案，以完善慢性患者筛查冠状动脉疾病的过程 等待名单上等待肾脏移植的肾脏疾病。目前，患者重复心脏 经常间隔进行筛查测试，其中很少会导致干预措施。这些测试施加了高度治疗 对患者的负担，并可能延迟移植时间，同时为患者带来不清楚的福利。这 授予提出的建议，以完善心脏筛查策略并为特定患者子组个性化（例如， 老年糖尿病患者）。它将检查会改变心脏测试频率的策略和 基于简单，廉价和非侵入性测试的心脏测试的风险分层 在常规临床环境中进行的6分钟步行测试（6MWT）进行。该项目将通过 三个具体目标：1）在识别不额外心脏的低风险患者时表征6MWT 测试； 2）建模策略改变了心脏测试的频率和6MWT的使用； 3）设计 针对特定患者子组的个性化策略，并在整个肾脏移植候选者中建模 美国人口（美国）。前两个目标将来自特征良好的患者队列 Cheng博士的机构。机器学习系统将用于确定哪些患者亚组是最好的 采用哪种策略（即响应的异质性）。第三个目标将利用美国肾脏数据 System，Cheng博士的导师和机构具有为创新研究的利用记录。 拟议的工作具有产生重大临床影响的很高潜力。它的完成将使 鉴定和表征冠状动脉疾病移植前筛查的理性策略 可以将其纳入临床实践或为将来的多中心比较铺平道路 有效试验。拟议的工作在颁奖期内是现实和可行的，将允许郑博士 建立研究技能，提高和传播科学知识，创建其他协作 网络，并争夺R01或同等资金。总而言之，K23奖将为 使Cheng博士成为成功的独立临床研究者。