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.

七、项目概要 该 K23 提案将为 Xingxing S. Cheng（医学博士、硕士）提供受保护的时间、指导、培训和 成为独立临床研究者的研究经验。郑博士是经过董事会认证的 肾病专家和认可的移植肾病专家，具有提高肾移植有效性的长期愿景 肾移植患者的保健。她寻求将以患者为中心的研究和决策结合起来 科学寻找临床问题的创新解决方案。她将在这笔赠款的指导下获得技能 强大的指导团队，包括1）以患者为中心的研究和决策分析模型的整合； 2) 评估不同患者亚组的反应异质性； 3）高级建模技能。 该赠款旨在完善慢性病患者冠状动脉疾病的筛查流程 肾脏疾病在等待肾移植的等候名单上。目前，患者接受重复心脏 频繁进行筛查测试，很少会导致干预措施。这些测试给予很高的待遇 增加患者的负担并可能延迟移植时间，同时给患者带来不明确的益处。这 grant 建议完善心脏筛查策略，并针对特定患者亚组（例如， 老年糖尿病患者）。它将检查改变心脏测试频率的策略 基于简单、廉价和非侵入性测试的心脏测试风险分层 在常规临床环境中进行 6 分钟步行测试 (6MWT)。该项目将通过以下方式实现这一广泛目标 三个具体目标：1) 描述 6MWT 的特征，以识别未进行额外心脏检查的低风险患者 测试； 2) 对改变心脏测试频率和 6MWT 使用的策略进行建模； 3）设计 针对特定患者亚组的个性化策略，并在整个肾移植候选者中进行建模 美国（US）的人口。前两个目标将来自于一群特征明确的患者 程博士的机构。机器学习系统将用于识别哪些患者亚组最好 由哪些策略提供服务（即响应的异质性）。第三个目标将利用美国肾脏数据 系统，程博士的导师和机构在利用该系统进行创新研究方面有着良好的记录。 拟议的工作很有可能产生重大的临床影响。它的完成将使 冠状动脉疾病移植前筛查合理策略的识别和表征 可能会纳入临床实践或为未来的多中心比较铺平道路 有效性试验。拟议的工作在奖励期限内是现实可行的，将使程博士 培养研究技能，推进和传播科学知识，建立更多的协作 网络，并争夺 R01 或同等资金。总而言之，K23 奖将为 使程博士成为一名成功的独立临床研究者。