Patient-Oriented Research Addressing Disparities in Hypertension and Kidney Disease

以患者为中心的研究解决高血压和肾脏疾病的差异

• 批准号: 10199020
• 负责人: DEIDRA CANDICE CREWS
• 金额: $ 10.99万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-17 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10199020
• 关键词: Address; Adherence; Adoption; Adult; Affect; African American; Age of Onset; Albumins; Albuminuria; Beverages; Blood Pressure; Cardiovascular Diseases; Chronic Kidney Failure; Clinical; Clinical Research Associate; DASH diet; Diet; Dietary Factors; Dietary Intervention; Dietary Practices; Disease Progression; Eating; End stage renal failure; Excretory function; Face; Faculty; Food; Future; Gifts; Goals; Health Food; Healthy Eating; Housing; Hypertension; Individual; Intervention; Intervention Studies; Interview; Kidney; Kidney Bean; Kidney Diseases; Kidney Failure; Knowledge; Lead; Low income; Medicine; Mentors; Mentorship; Mid-Career Clinical Scientist Award (K24); Midcareer Investigator Award in Patient-Oriented Research; Nephrology; Nutritional; Nuts; Observational Study; Outcome; Participant; Pattern; Persons; Phase; Phase Transition; Postdoctoral Fellow; Prevention Research; Randomized; Reporting; Research; Research Methodology; Research Personnel; Resources; Risk; Scholarship; Socioeconomic Factors; Structure; Students; Time; Universities; Work; base; career; dietary; disadvantaged population; disorder risk; disparity reduction; epidemiology study; ethnic minority population; experience; food desert; food insecurity; fruits and vegetables; good diet; group intervention; health equity; high risk; implementation research; improved outcome; indexing; low socioeconomic status; medical schools; mid-career faculty; patient oriented research; phase 1 study; primary outcome; racial and ethnic; racial difference; racial disparity; randomized trial; renal damage; research and development; secondary outcome; socioeconomic disadvantage; therapy design; treatment arm; treatment as usual; urinary

PROJECT SUMMARY/ABSTRACT This is a proposal for a K24 Midcareer Investigator Award in Patient-Oriented Research for Deidra C. Crews, MD, ScM of Johns Hopkins University School of Medicine. Dr. Crews is an Associate Professor of Medicine in the Division of Nephrology, Core Faculty in the Welch Center for Prevention, Epidemiology and Clinical Research, and Associate Director for Research Development in the Center for Health Equity. Dr. Crews has spent the majority of her career and scholarship focused on patient-oriented research in disadvantaged populations with hypertension and/or chronic kidney disease (CKD). African Americans are disproportionately affected by hypertension and CKD, and socioeconomic factors contribute to these disparities. Racial disparities in CKD are most profound among socioeconomically disadvantaged populations. Low socioeconomic status (SES) and limited availability of healthy foods contribute to poor dietary patterns which influence CKD risk. There is evidence from observational studies that adherence to healthy dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH) diet, may substantially reduce risk of CKD and short-term randomized trials suggest the adoption of a healthy diet in adults with CKD may reduce risk of disease progression. The important problem to be addressed by the applicant over the proposed 5-year K24 award period is that low SES African Americans with hypertension and CKD face multiple barriers to healthful eating which can lead to their poor outcomes, including cardiovascular disease and ESRD. This K24 award will protect time for the applicant to mentor junior investigators and conduct significant research aimed at developing sustainable dietary interventions for individuals at high risk for poor clinical outcomes related to hypertension and CKD. The proposed original research will be conducted in the context of the Five, Plus Nuts and Beans for Kidneys trial, a randomized controlled dietary intervention study of low SES African Americans with hypertension and CKD, and will (a) elucidate experiences of recent intervention-arm (Coaching-DASH) participants determining their views on intervention components and factors facilitating or impeding their dietary changes, (b) examine the purchase patterns of the usual care group (Shopping-DASH), who received a trackable gift card to a local grocer but no guidance on purchases and (c) characterize and determine the impact of financial resource strain (defined as housing and/or food insecurity) on the primary and secondary outcomes of the trial—reductions in urinary albumin excretion and blood pressure. These aims will be addressed while Dr. Crews provides mentorship to new and existing junior faculty, post-doctoral fellows and students. Work performed during the K24 award will both inform future intervention design and implementation approaches to maximize sustainability of the applicant’s work, and will allow her to more effectively pursue her long-term career goals to improve outcomes for disadvantaged populations with or at risk for CKD.

项目摘要/摘要 这是一份关于Deidra C.Crews以患者为中心的研究的K24职业中期研究员奖的建议， 约翰霍普金斯大学医学院医学博士、医学博士。克鲁斯博士是华盛顿大学的医学副教授 韦尔奇预防、流行病学和临床中心的核心教员--肾脏科 他是卫生公平中心负责研究发展的副主任。克鲁斯博士有 她在职业生涯和学术研究中的大部分时间都专注于以患者为中心的弱势群体研究 患有高血压和/或慢性肾脏疾病(CKD)的人群。非洲裔美国人不成比例 受高血压和慢性肾脏病的影响，社会经济因素导致了这些差异。种族差距 在CKD中，在社会经济上处于不利地位的人群中最为严重。社会经济地位低 营养不良(SES)和健康食品供应有限导致不良的饮食模式，从而影响CKD的风险。 来自观察性研究的证据表明，坚持健康的饮食模式，如节食 停止高血压(DASH)饮食的方法，可能会显著降低CKD和短期 随机试验表明，对患有慢性肾脏病的成年人采用健康饮食可能会降低患病风险。 进步。申请人就拟议的5年期K24奖励所要解决的重要问题 时期是患有高血压和慢性肾脏病的低SES非裔美国人在健康饮食方面面临着多重障碍 这可能会导致他们的不良结局，包括心血管疾病和终末期肾病。这个K24奖将 保护申请人指导初级调查人员的时间，并进行旨在 为临床预后不良的高危人群开发可持续的饮食干预措施 高血压和慢性肾脏病。拟议的原始研究将在五加坚果的背景下进行 和豆类换肾脏试验，一项针对低SES非裔美国人的随机对照饮食干预研究 高血压和慢性肾脏病，并将(A)阐明最近的干预经验-ARM(教练员-冲刺) 参与者决定他们对干预措施的组成部分和促进或阻碍其 饮食变化，(B)检查通常护理组(Shopping-Dash)的购买模式，他们收到了 向当地杂货商提供可跟踪的礼品卡，但没有购买指南；以及(C)描述并确定 财政资源紧张(定义为住房和/或粮食不安全)对初级和次级 试验结果-减少尿白蛋白排泄和血压。这些目标将是 在Crews博士为新的和现有的初级教员、博士后研究员和 学生们。在K24获奖期间完成的工作将为未来的干预设计和实施提供信息 使申请人工作的可持续性最大化的方法，并将使她能够更有效地从事她的工作 长期的职业目标，以改善患有或处于CKD风险中的弱势人群的结果。